Discordant grading of severity of aortic stenosis

Discordant grading of severity of aortic stenosis Discordance between various measures of severity of aortic stenosis (AS) is considered as discordant grading of severity of aortic stenosis or simply discordant AS. Severe aortic stenosis has aortic Vmax ≥4.0 m/s, mean gradient ≥40 mm Hg and effective orifice area (EOA) ≤1.0 sq. cm. Peak aortic velocity and mean gradient are flow dependent measurements, while effective orifice area and Doppler velocity index are relatively flow independent. About 20-30% of patients may have discordant measures of severity of aortic stenosis on echocardiography [1]. Discordance is mostly between effective orifice area and Vmax/Doppler gradients. Low gradient and Vmax may occur with small EOA. So the usual discordant AS has EOA ≤1.0 sq. cm and mean gradient <40 mm Hg [2]. Low flow low gradient severe aortic stenosis has low stroke volume with stroke volume index <35 ml/sq. m. Low stroke volume index can occur with reduced left ventricular ejection fraction or with preserved ejection fraction. Lower stroke volume index is associated incrementally with mortality in low gradient severe aortic stenosis with preserved ejection fraction [3]. Most frequent cause of low gradient aortic stenosis is a low left ventricular outflow state. This could be due to reduced left ventricular ejection which is the classical low flow low gradient aortic stenosis. When there is low flow with preserved ejection fraction, it is paradoxical low flow low gr...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Echocardiography discordant aortic stenosis discordant AS hybrid imaging hybrid imaging to assess LVOT measurement pseudo severe aortic stenosis pseudo severe AS Source Type: blogs