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Low-flow Low-gradient Aortic Stenosis — EECC MCQ

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HardValvular Heart DiseaseLow-flow Low-gradient Aortic StenosisEECC

An 82-year-old man with low-flow, low-gradient aortic stenosis (AVA 0.8 cm2, mean gradient 28 mmHg, stroke volume index 30 mL/m2, LVEF 35%) undergoes a low-dose dobutamine stress echocardiogram. At peak stress, the mean gradient rises to 42 mmHg, AVA remains 0.75 cm2, and LVEF increases to 42%. What is the significance of these findings and the recommended management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — True severe AS with contractile reserve; intervention is recommended

Explanation lettering: B = shown as A · D = shown as B · E = shown as C · C = shown as D · A = shown as E

The dobutamine stress test demonstrates both contractile reserve (LVEF improvement) and persistence of severe AS (AVA remains below 1.0 cm2 with gradient rising above 40 mmHg), confirming true severe AS. Per the 2025 ESC/EACTS VHD Guidelines, intervention is recommended. Contractile reserve is a positive prognostic factor. Pseudo-severe AS (B) would show AVA increasing above 1.0 cm2. Option D is incorrect as contractile reserve is present. Exercise stress (E) is inappropriate with reduced LVEF.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease