Aortic Valve Calcification Alone Identifies Transcatheter Aortic Valve Replacement Benefit in Classical Low-Flow, Low-Gradient Aortic Stenosis

Aortic valve calcification (AVC) is a guideline-endorsed diagnostic tool in low-flow, low-gradient (LFLG) aortic stenosis (AS), but its prognostic value across LFLG subtypes remains debated. In this retrospective cohort of 457 patients undergoing transcatheter aortic valve replacement (TAVR), severe AVC was associated with significantly fewer heart failure rehospitalizations in classical LFLG AS (adjusted hazard ratio [HR], 0.41; P = .023) but not in paradoxical LFLG AS (adjusted HR, 0.76; P = .422). AVC also correlated with true-severe AS when dobutamine stress echocardiography (DSE) was performed. These findings suggest that AVC alone can identify classical LFLG AS patients likely to benefit from TAVR, even when DSE results are unavailable or inconclusive.