Editorial

DOI: 10.4244/EIJ-E-24-00052

Low-flow, low-gradient aortic stenosis: an understanding is still a long way off

John Webb1,2, MD; Sophie Offen1,2, MBBS, PhD

Low-gradient (LG) aortic stenosis (AS) is estimated to account for at least one-third of all presentations in patients with suspected severe AS. Even though frequently encountered in clinical practice, patients with LG-AS are less likely to be referred for aortic valve replacement (AVR) compared to those with high-gradient (HG) AS, despite evidence to suggest a survival benefit with AVR over conservative management1. At least part of this therapeutic inertia is no doubt secondary to the ongoing diagnostic challenge associated with the correct adjudication of stenosis severity in patients presenting with discordant markers of AS severity on initial transthoracic echocardiography. Current society guidelines advocate a stepwise integrated approach for the diagnosis of LG-AS, utilising dobutamine stress echocardiography (DSE) and/or computed tomography calcium score, in patients with an aortic valve area <1 cm2 and a mean gradient <40 mmHg2. These additional diagnostic modalities are intended to classify patients into 1 of 2 dominant patterns in LG-AS: classical low-flow, LG-AS (cLFLG-AS), in patients with a depressed left ventricular ejection fraction (LVEF; <50%), and paradoxical LFLG-AS (pLFLG-AS), in those with a normal...

Sign in to read
the full article

Forgot your password?
No account yet?
Sign up for free!

Create my pcr account

Join us for free and access thousands of articles from EuroIntervention, as well as presentations, videos, cases from PCRonline.com

Volume 20 Number 22
Nov 18, 2024
Volume 20 Number 22
View full issue


Key metrics

Suggested by Cory

10.4244/EIJV10I7A134 Nov 20, 2014
Low-flow, low-gradient aortic stenosis: should TAVI be the default therapeutic option?
O’Sullivan C and Wenaweser P
free

10.4244/EIJV10SUA8 Sep 27, 2014
Assessment of low-flow, low-gradient aortic stenosis: multimodality imaging is the key to success
Clavel M-A and Pibarot P
free

Original Research

10.4244/EIJ-D-24-00442 Nov 18, 2024
Long-term survival after TAVI in low-flow, low-gradient aortic valve stenosis
Cardaioli F et al

Debate

10.4244/EIJ-E-22-00039 Nov 18, 2022
TAVI in moderate aortic stenosis and heart failure: pros and cons
Delgado V et al
free

Editorial

10.4244/EIJ-E-23-00054 Dec 4, 2023
Cardiac damage staging in the flow-gradient patterns of aortic stenosis
Pibarot P and Tastet L
free

Viewpoint

10.4244/EIJ-D-24-00164 Jul 15, 2024
TAVI in moderate aortic stenosis: the earlier the better?
Schofer N and Ludwig S
free
Trending articles
318.1

State-of-the-Art Review

10.4244/EIJ-D-21-00695 Nov 19, 2021
Transcatheter treatment for tricuspid valve disease
Praz F et al
free
116.5

State-of-the-Art

10.4244/EIJ-D-24-00066 Apr 21, 2025
Management of complications after valvular interventions
Bansal A et al
free
108.3

Viewpoint

10.4244/EIJ-E-22-00007 May 15, 2022
TAVI at 20: how a crazy idea led to a clinical revolution
Eltchaninoff H et al
free
91.6

Image – Interventional flashlight

10.4244/EIJ-D-22-00344 Aug 5, 2022
First dedicated transcatheter leaflet splitting device: the ShortCut device
Tchétché D et al
free
72.15

State-of-the-art

10.4244/EIJ-D-22-00627 Feb 6, 2023
Left atrial appendage occlusion
Holmes D et al
free
68.9

State-of-the-Art

10.4244/EIJ-D-24-00992 Sep 15, 2025
Antithrombotic therapy in complex percutaneous coronary intervention
Castiello D et al
free
49.55

CLINICAL RESEARCH

10.4244/EIJ-D-17-00962 Apr 6, 2018
A new optical coherence tomography-based calcium scoring system to predict stent underexpansion
Fujino A et al
free
43.45

State-of-the-Art Review

10.4244/EIJ-D-21-00145 Sep 20, 2021
Robotics, imaging, and artificial intelligence in the catheterisation laboratory
Beyar R et al
free
X

PCR
Impact factor: 9.5
2024 Journal Citation Reports®
Science Edition (Clarivate Analytics, 2025)
Online ISSN 1969-6213 - Print ISSN 1774-024X
© 2005-2025 Europa Group - All rights reserved