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                <title level="j">Archives of cardiovascular diseases</title>
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                  <publisher>Elsevier ; Société française de cardiologie [2008-....]</publisher>
                  <biblScope unit="volume">111</biblScope>
                  <biblScope unit="issue">8-9</biblScope>
                  <biblScope unit="pp">518-527</biblScope>
                  <date type="datePub">2018</date>
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              <keywords scheme="author">
                <term xml:lang="en">Aortic stenosis</term>
                <term xml:lang="en">Bas gradient</term>
                <term xml:lang="en">Doppler echocardiography</term>
                <term xml:lang="en">Low gradient</term>
                <term xml:lang="en">Pressure recovery</term>
                <term xml:lang="en">Restitution de pression</term>
                <term xml:lang="en">Rétrécissement aortique</term>
                <term xml:lang="en">Échocardiographie Doppler</term>
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              <p>Background. - The frequency of paradoxical low-gradient severe aortic stenosis (AS) varies widely across studies. The impact of misalignment of aortic flow and pressure recovery phenomenon on the frequency of low-gradient severe AS with preserved left ventricular ejection fraction (LVEF) has not been evaluated in prospective studies. Aims. - To investigate prospectively the impact of aortic flow misalignment by Doppler and lack of pressure recovery phenomenon correction on the frequency of low-gradient (LG) severe aortic stenosis (AS) with preserved LVEF. Methods. - Aortic jet velocities and mean pressure gradient (MPG) were obtained by interrogating all windows in 68 consecutive patients with normal LVEF and severe AS (aortic valve area [AVA] &lt;= 1 cm(2)) on the basis of the apical imaging window alone (two-dimensional [2D] apical approach). Patients were classified as having LG or high-gradient (HG) AS according to MPG &lt; 40 mmHg or &gt;= 40 mmHg, and normal flow (NF) or low flow (LF) according to stroke volume index &gt; 35 mL/m(2) or &lt;= 35 mL/m(2), on the basis of the 2D apical approach, the multiview approach (multiple windows evaluation) and AVA corrected for pressure recovery. Results. - The proportion of LG severe AS was 57% using the 2D apical approach alone. After the multiview approach and correction for pressure recovery, the proportion of LG severe AS decreased from 57% to 13% (LF-LG severe AS decreased from 23% to 3%; NF-LG severe AS decreased from 34% to 10%). As a result, 25% of patients were reclassified as having HG severe AS (AVA &lt;= 1 cm(2) and MPG &gt;= 40 mmHg) and 19% as having moderate AS. Hence, 77% of patients initially diagnosed with LG severe AS did not have ``true'' LG severe AS when the multiview approach and the pressure recovery phenomenon correction were used. Conclusions. - Aortic flow misevaluation, resulting from lack of use of multiple windows evaluation and pressure recovery phenomenon correction, accounts for a large proportion of incorrectly graded AS and considerable overestimation of the frequency of LG severe AS with preserved LVEF. (C) 2018 Elsevier Masson SAS. All rights reserved.</p>
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