🫀 ECHO CHALLENGE
A 68-year-old patient presents with exertional dyspnea. Echocardiography shows:
LVEF: 60%
Aortic valve area: 0.8 cm²
Mean transvalvular gradient: 28 mmHg
Peak velocity: 3.4 m/s
Stroke volume index: 32 mL/m²
What is the most likely diagnosis?
A. Moderate aortic stenosis
B. Severe high-gradient aortic stenosis
C. Classical low-flow, low-gradient severe aortic stenosis
D. Paradoxical low-flow, low-gradient severe aortic stenosis
⬇️ Your Answer?
Correct answer: D — Paradoxical low-flow, low-gradient severe aortic stenosis.
Why?
The patient has a preserved LVEF but reduced stroke volume index (<35 mL/m²), an AVA ≤1.0 cm², and a mean gradient <40 mmHg—consistent with paradoxical low-flow, low-gradient AS.
2September 7, 2026 162 2
