Prognostic Implications of Discordant Low-Gradient Severe Aortic Stenosis: A Comprehensive Review of Pathophysiological Mechanisms, Diagnostic Challenges, and Clinical Outcomes
Year: 2025
Type: article
Abstract: Discordant low-gradient severe aortic stenosis (DLG-SAS) represents a clinically complex and prognostically heterogeneous entity characterized by a discrepancy between aortic valve area (AVA) criteria for severe stenosis (AVA <1.0 cm²) and a non-classical transvalvular gradient (mean gradient <40 mmHg). This condition poses significant diagnostic and therapeutic dilemmas due to its multifactorial pathophysiology, which includes impaired left ventricular (LV) systolic function (classical low-flow, low-gradient SAS), preserved LV ejection fraction with paradoxical low-flow states, and measurement artifacts. Emerging evidence suggests that DLG-SAS carries distinct prognostic implications, with varying mortality risks depending on underlying hemodynamic profiles, comorbidities, and therapeutic interventions. This review synthesizes current literature on the pathophysiological substrates, advanced imaging modalities (e.g., dobutamine stress echocardiography, computed tomography-derived aortic valve calcification scoring), and risk stratification paradigms. Furthermore, we evaluate the impact of treatment strategies, including transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR), on long-term outcomes. By elucidating the interplay between hemodynamic parameters, myocardial remodeling, and clinical trajectories, this article aims to refine prognostic assessment and guide evidence-based management of DLG-SAS.
Authors: José Eduardo Gómez Garay, Yoselin Esparza Monreal, Donaldo Emiliano Silva López, Pedro Luis Matus Rojo, Miguel Ángel Espidio Coello, Ivana Leilani Júnez Villicaña, Jhonattan Daniel Castro Pérez, Francisco Rivera Martinez, Karla Teresa Granados Velasco, Israel Eliud Villalpando Valdez, Sebastián Jiménez Andrade, Paloma Guadalupe Cardona Chávez, Bryan Xavier Soto Gutiérrez, José Antonio Jiménez Muñoz
Institutions: Autonomous University of Aguascalientes, Universidad Autónoma de Zacatecas "Francisco García Salinas", Tecnológico de Monterrey, Benemérita Universidad Autónoma de Puebla, Universidad Michoacana de San Nicolás de Hidalgo, Autonomous University of Durango, University of the Valley of Atemajac, Universidad Anáhuac, Universidad Cuauhtémoc
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W6949348241
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