Low-Gradient Severe Aortic Stenosis with Preserved Left Ventricular Function: A New Disease?

An analysis of prospective data helps to elucidate the characteristics and course of a common, clinically distinct form of AS.


Recent studies have identified a variant of severe aortic stenosis (AS) that is characterized by a low transvalvular gradient and a preserved left ventricular ejection fraction (LVEF) associated with low stroke volume. In this observational substudy of the SEAS trial, investigators compared outcomes in 435 asymptomatic patients with low-gradient severe AS (echocardiographic valve area, <1.0 cm2; mean gradient, ?40 mm Hg) and 184 asymptomatic patients with moderate AS (valve area, 1.0–1.5 cm2; mean gradient, 25–40 mm Hg). All had LVEFs ?55%.

The patients with low-gradient severe AS were older and had higher systolic blood pressures and lower body-mass indexes than those with moderate AS, and more of them were women. At a mean follow-up of almost 4 years, the rates of cardiac death and other major adverse events did not differ significantly between the low-gradient severe and moderate groups (annualized event rates, 1%–2% and 14%–15%, respectively). Aortic valve replacement was performed in about 40% of patients in both groups.


Citation(s):

Jander N et al. Outcome of patients with low-gradient "severe" aortic stenosis and preserved ejection fraction. Circulation 2011 Mar 1; 123:887.

Zoghbi WA. Low-gradient "severe" aortic stenosis with normal systolic function: Time to refine the guidelines? Circulation 2011 Mar 1; 123:838.