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Symptomatic severe aortic stenosis — ABIM Board MCQ

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HardCardiovascularSymptomatic severe aortic stenosisABIM Board

A 77-year-old man has exertional dyspnea. Echocardiography shows a calcified aortic valve, LVEF 35%, valve area 0.8 cm², mean gradient 28 mm Hg and stroke-volume index 30 mL/m². Blood pressure is controlled. Which test best distinguishes true severe aortic stenosis from pseudo-severe stenosis?

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Correct answer: E — Perform low-dose dobutamine stress echocardiography to assess valve hemodynamics

The best answer is “Perform low-dose dobutamine stress echocardiography to assess valve hemodynamics”. This is classical low-flow, low-gradient aortic stenosis with reduced ejection fraction. Low-dose dobutamine assesses flow reserve and whether valve velocity and gradient rise while the calculated valve area remains severely reduced, supporting true severe fixed obstruction.

Reference: 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: https://pubmed.ncbi.nlm.nih.gov/33972115/