Low-Flow Low-Gradient and Low-Ejection Fraction Aortic Stenosis and Projected Aortic Valve Area Calculation: So Important but so Complicated. Let us Just Keep it Simple!

DOI: 10.5935/abc.20180030 Low-flow low-gradient aortic stenosis with low ejection fraction is still one of the main challenges not only for echocardiography but to cardiology itself. It is the very late stage of aortic stenosis that portends very poor prognosis with medical treatment, in addition to a very high operative mortality.1 In subjects with that condition, dobutamine stress echocardiography is of paramount importance to stratify aortic stenosis status (real aortic stenosis vs pseudo aortic stenosis) and to predict surgical mortality by the evaluation of the left ventricular contractile reserve status.1-3