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Background

Paradoxical low-flow severe aortic stenosis (LF AS) despite preserved left ventricular ejection fraction (LVEF) has been shown to be distinct from normal-flow (NF) AS, with poorer prognosis. Relative valve load (RVL) is an echocardiographic index which has been used to estimate the relative contribution of the valvular load to the global LV afterload. We examined RVL in LF AS compared to NF.

Methods

We examined 450 consecutive patients with index echocardiographic diagnosis of severe AS (aortic valve area< 1cm 2) with preserved LVEF (> 50%). They were divided based on LF (stroke volume index< 35ml/m 2) or NF. RVL was estimated by the ratio of transaortic mean pressure gradient (MG) to global valvuloarterial impedance (Zva). Appropriate univariate and multivariate analyses were performed to compare LF and NF.

Results

There were 149 (33.1%) patients were LF. RVL was inversely …