Management and prognosis of low gradient aortic stenosis
- Dania Mohty, MD, PhD
Dania Mohty, MD, PhD
- Professor of Cardiology
- CHU Limoges, Limoges
- Section Editors
- Patricia A Pellikka, MD, FACC, FAHA, FASE
Patricia A Pellikka, MD, FACC, FAHA, FASE
- Section Editor — Noninvasive Cardiac Imaging and Stress Testing
- Professor of Medicine
- Mayo Clinic College of Medicine
- Stephen JD Brecker, MD, FRCP, FESC, FACC
Stephen JD Brecker, MD, FRCP, FESC, FACC
- Section Editor — Valvular and Aortic Disease
- Chief of Cardiology
- Clinical Academic Group
- St. George's Hospital & University of London
Degenerative valvular heart disease (VHD) is common and is the third most frequent cause of cardiac disease after hypertension and coronary artery disease in developed countries with aging populations. Among patients with at least moderate VHD in developed countries, aortic valve stenosis (AS) is most common, followed by mitral regurgitation, then aortic regurgitation and finally mitral stenosis .
For appropriate diagnosis and management of AS, it is crucial to assess the severity of AS accurately as possible. However, the diagnosis and evaluation of AS are challenging due to a variety of pitfalls.
The management and prognosis of low gradient AS will be reviewed here. Clinical manifestations and diagnosis of low gradient AS and the clinical presentation and treatment of high gradient severe AS are discussed separately. (See "Clinical manifestations and diagnosis of low gradient severe aortic stenosis" and "Clinical manifestations and diagnosis of aortic stenosis in adults" and "Medical management of symptomatic aortic stenosis" and "Medical management of asymptomatic aortic stenosis in adults" and "Indications for valve replacement in aortic stenosis in adults", section on 'Low gradient aortic stenosis'.)
Approach to management — Management of patients with low gradient aortic stenosis AS starts with confirming the severity and type of AS. Subsequent steps include referral of patients with symptomatic true severe AS to a heart valve team for possible aortic valve replacement, monitoring asymptomatic patients, preventive measures to reduce risk of decompensation, and pharmacologic therapy to treat risk factors in asymptomatic patients and as a temporizing or palliative measure in symptomatic patients.
Confirmation of AS severity and type — Key steps in the management of patients with low gradient AS are to confirm the AS severity and type (see "Clinical manifestations and diagnosis of low gradient severe aortic stenosis", section on 'Diagnosis and evaluation'):To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Approach to management
- Confirmation of AS severity and type
- Choice of therapy
- - Indications for referral to heart valve team
- - Evidence on the impact of aortic valve replacement
- For classical low flow low gradient AS
- For paradoxical low flow low gradient AS
- For normal flow low gradient AS
- - Evidence on the impact of transcatheter aortic valve implantation
- Evaluation of potential candidates for aortic valve replacement
- - Referral to heart valve team
- - Investigational pre-procedural tests
- Contractile reserve as a prognostic indicator
- Natriuretic peptides
- Measures of systolic function
- Role of palliative care
- General management
- Pharmacologic therapy
- - For patients with pseudo-severe AS
- - For patients with true severe AS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS