AS Severity Grading Discordance — EECC MCQ
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Correct answer: C — Moderate AS — severe AS requires ALL of: peak velocity ≥4.0 m/s, mean gradient ≥40 mmHg, AND AVA ≤1.0 cm²; discordance between gradient and AVA (as here — gradient borderline severe but AVA above 1.0) requires careful clinical assessment
AS severity grading requires integration of multiple parameters. The 2025 ESC VHD Guidelines define severe AS as: peak velocity ≥4.0 m/s AND mean gradient ≥40 mmHg AND AVA ≤1.0 cm² (indexed AVA ≤0.6 cm²/m²). When parameters are discordant (as here — velocity 4.2 m/s and gradient 40 mmHg suggest severe, but AVA 0.9 cm² is borderline), causes of discordance should be investigated: (1) small body size (use indexed AVA); (2) measurement errors (LVOT diameter measurement is the commonest source); (3) hypertension (elevated afterload increases gradients disproportionately); (4) concomitant AR (increases flow across the AV, elevating velocity/gradient). Repeat measurement with attention to technical accuracy, and CT calcium scoring, may help resolve discordance.
Reference: ESC/EACTS (2025): VHD Guidelines