My Approach to Aortic Stenosis Assessment with Discrepant Quantification

Introduction

Aortic stenosis (AS) is the most common primary valve disease and an important cause of morbidity and mortality worldwide. Echocardiography is the first-line method for its diagnosis, quantification of severity, prognosis, and determination of intervention timing.

The association of maximum velocity (Vmax) ≥ 4m/s, aortic valve area (AVA) ≤ 1.0 cm², and mean gradient (MG) ≥ 40 mmHg defines the diagnosis of classic severe AS. However, MG and AVA are discrepant (AVA ≤ 1.0 cm², MG < 40 mmHg) in 30–40% of the population with severe AS, leading to low-gradient AS (LGAS), the focus of this article. Less frequently, high-gradient AS can also occur in cases of MG ≥ 40 mmHg and AVA > 1.0 cm² due to high flow situations.

[…]