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Low-Gradient AS Dx — RACP Adult Medicine MCQ

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HardCardiologyLow-Gradient AS DxRACP Adult Medicine

A patient has suspected low-flow, low-gradient severe aortic stenosis, but dobutamine stress echocardiography shows no flow reserve and remains indeterminate. Which complementary test can help adjudicate anatomical severity?

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Correct answer: C — Use non-contrast CT aortic-valve calcium scoring with sex-specific thresholds

The best answer is “Use non-contrast CT aortic-valve calcium scoring with sex-specific thresholds”. When stress echocardiography cannot generate enough flow, CT quantification of aortic-valve calcification provides a flow-independent measure and sex-specific thresholds support true severe stenosis. Coronary calcium is not interchangeable with valve calcium, and repeating a nondiagnostic stress test or using unrelated biomarkers does not resolve anatomical severity.

Reference: Heart Foundation: Australian clinical guidelines and position statements: https://www.heartfoundation.org.au/for-professionals/clinical-guidelines-position-statements ACC/AHA: Valvular heart disease guideline: https://www.acc.org/Guidelines/Hubs/Valvular-Heart-Disease