Conference Proceeding - Restricted Access
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.
Mando R, Madanat L, Almany SL, Hanson I, Gallagher MJ, Shannon FL, et al [Renard BM, Hanzel GS, Vivacqua A, Abbas AE] Multimodality assessment of low flow low gradient aortic stenosis with low ejection fraction. J Am Coll Cardiol. 2022 Mar 8;79(9 Suppl):739.