Document Type

Conference Proceeding - Restricted Access

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Publication Title

Journal of the American College of Cardiology


Background: Low flow low gradient (LFLG) aortic stenosis (AS) with low ejection fraction is a diagnostic dilemm. Multiple modalities including aortic valve calcium score (AVCS), CTA Planimetry, invasive hemodynamics, and dobutamine stress echocardiography (DSE) may be required to assess true severity. Methods: We retrospectively studied patients who underwent DSE for LFLG AS with an aortic valve area (AVA) < 1 cm2, mean gradient < 40 mmHg, and an EF < 40. DSE results were as follows: Indeterminate: stroke volume (SV) increase < 20% from baseline, Pseudo-severe (PS): SV > 20% and AVA > 1 cm2, or Severe: SV increase > 20% and AVA < 1.0 cm2. AVCS > 2000 AU and 1300 were considered severe for males and females, respectively. AS was defined as severe if planimetry AVA < 1.0 cm2 or invasive iAVA was < 0.6 cm2/m2. AS severity was compared by DSE, CT, and invasive iAVA. Results: 26 patients were included. By DSE, we identified 14 indeterminate, 7 severe, and 5 PS cases. Of the 14 indeterminate AS, 93%, 69%, and 60% were classified as non-severe by AVCS, planimetry, and invasive iAVA, respectively. Of the 7 severe AS by DSE, 33%, 17%, and 67% were classified as severe by AVCS, planimetry, and invasive iAVA, respectively. No PS severe AS patients by DSE were classified as severe AS by AVCS, planimetry, or invasive iAVA. Conclusion: The majority of DSE have indeterminate results. Of patients with PS AS by DSE, none were severe by other modalities. Significant disagreement between different modalities exists in patients with LFLG.




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