Normal-flow low-gradient severe aortic stenosis is a frequent and real entity

Low-gradient aortic stenosis (AS) [i.e. an aortic valve area (AVA) <1 cm2 with a mean transvalvular gradient <40 mmHg and/or peak jet aortic velocity <4 m/s] is a frequent finding, with up to 40% AS patients harbouring discrepant results at transthoracic echocardiography (TTE) examination.1 This discordant grading pattern raises challenges and uncertainties regarding the true severity of the valve disease. Therefore, a thorough, integrative approach including assessment of flow status has been proposed in recent guidelines