Paradoxical Low-flow Low-gradient Aortic Stenosis
Also written as: PLF-LG AS — Paradoxical Low-flow Low-gradient Aortic Stenosis
A subset of severe aortic stenosis with preserved ejection fraction but reduced stroke volume, commonly seen in elderly patients with small ventricular cavities.
Full Definition
Paradoxical low-flow low-gradient aortic stenosis represents a challenging diagnostic entity characterized by severe aortic stenosis (valve area ≤1.0 cm²) with preserved left ventricular ejection fraction (≥50%) but reduced stroke volume index and low mean gradient across the aortic valve. This condition is particularly prevalent in elderly patients, especially women, and is associated with small, stiff left ventricles, concentric remodeling, and restrictive physiology. The 'paradoxical' designation reflects the unexpected combination of preserved systolic function with reduced flow parameters. Diagnosis often requires dobutamine stress echocardiography or cardiac catheterization to differentiate from pseudo-severe stenosis. These patients typically have poor outcomes with medical therapy and benefit from aortic valve intervention, though the timing and approach require careful consideration given the complex hemodynamics involved.
Usage
Usage note: Often abbreviated as PLF-LG AS in clinical documentation; requires specific hemodynamic criteria for diagnosis.
In Context
- "Dobutamine stress echocardiography confirmed paradoxical low-flow low-gradient aortic stenosis in the 82-year-old patient." — Cardiac imaging report
- "The diagnosis of paradoxical low-flow low-gradient aortic stenosis was challenging due to preserved ejection fraction." — Cardiology consultation