Insights into the mechanism of paradoxical low-flow, low-pressure gradient severe aortic stenosis: association with reduced O2 consumption by the whole body

The mechanism of reduced stroke volume index (SVi) in paradoxical low-flow, low- pressure gradient (PLFLPG) aortic stenosis (AS) remains unclarified. Guyton et al. (21) demonstrated that SVi is determined by whole body O-2 consumption (<(V)over dot>O-2) in many subjects, including patients with heart disease. We hypothesized that reduced SVi in PLFLPG AS is associated with reduced <(V)over dot>O-2 by the whole body. This study investigated the relationship between <(V)over dot>O-2, SVi, and AS severity in patients with AS to examine the association between reduced <(V)over dot>O-2 and PLFLPG AS. In 59 patients (24 men and 35 women, mean age: 78 +/- 7 yr old) with severe AS, SVi, AS severity, and type were evaluated by echocardiography, and <(V)over dot>O-2 was measured by the fraction of O-2 in expired gases. SVi and V.O-2 were significantly decreased in 20 patients with PLFLPG AS compared with 39 patients with non- PLFLPG AS (30 +/- 4 vs. 41 +/- 7 ml/m(2) and 2.4 +/- 0.5 vs. 3.0 +/- 0.5 ml.min(-1).kg(-1), respectively, P < 0.01). The SVi-to-<(V)over dot>O-2 ratio was not different between the two groups (13.1 +/- 2.6 vs. 13.6 +/- 2.1, not significant). SVi was independently correlated with <(V)over dot>O-2 (r = 0.74, P < 0.01) but not with the aortic valve area index. Categorized PLFLPG AS was also significantly associated with reduced <(V)over dot>O-2 (P < 0.001). PLFLPG AS is associated with reduced <(V)over dot>O-2 by the whole body, which may offer insights into the mechanism of PLFLPG AS. NEW & NOTEWORTHY Paradoxical low- flow, low- pressure gradient severe aortic stenosis (PLFLPG AS) is an important and problematic subtype, and its central pathophysiology with reduced stroke volume is yet to be clarified. We hypothesized and subsequently clarified that reduced stroke volume in PLFLPG AS is associated with reduced O-2 consumption by the whole body. This study suggests important insights into the mechanism of PLFLPG AS and may further promote studies to investigate further mechanisms and novel treatment.