Low-flow/low-gradient aortic stenosis without contractile reserve—a case report. Issue 7 (1st July 2022)

• Record Type: Journal Article
• Authors: Stastny, Lukas; Dumfarth, Julia; Friedrich, Guy; Bonaros, Nikolaos
• Editors: De Potter, Tom; Sá, Michel Pompeu; Phan, Derek; Brown, Oliver Ian; Fawzy, Ameenathul Mazaya
• Is Part Of: European heart journal. Volume 6:Issue 7(2022)
• Publication Date: 2022-07-01
• Subjects: Low-flow/low-gradient aortic stenosis -- Dobutamine stress echocardiography -- Cardiac computed tomography -- Case report; Cardiology -- Periodicals; Cardiology -- Case studies -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Diseases -- Case studies -- Periodicals; 616.12
• DOI: 10.1093/ehjcr/ytac273
• Languages: English
• ISSNs: 2514-2119

Abstract

Abstract: Background: Diagnosis and management of low-flow/low-gradient aortic stenosis are very challenging. Resting echocardiography is not capable of differentiating between different types and origins of low-flow and low-gradient state in aortic valve stenosis. Therefore, dobutamine stress echocardiography (DSE) and cardiac computed tomography (CCT) are necessary. This case report should illustrate the importance of these assessments. Case summary: A 73-year-old woman presented to our emergency department with New York Heart Association III symptoms of exertional dyspnoea. In addition, the patient complained of fatigue and low resilience. On physical examination, auscultation revealed a systolic murmur over the aortic valve. Further diagnostic steps revealed a low-flow/low-gradient aortic valve stenosis (LF/LGAS) without contractile reserve (CR) in DSE and massive valve calcification in CCT. Discussion: In this case, we demonstrate the importance of different assessments and workflow. The prognosis of LF/LGAS has been re-evaluated during the last decade and the current guidelines recommend the treatment of such patients even in the absence of CR. Furthermore, we are discussing the results of LF/LGAS.