Dynamic left ventricular dyssynchrony: a potential cause of no contractile reserve in patients with low-gradient aortic stenosis.

Dobutamine stress echocardiography (DSE) has the potential to stratify patients with low-gradient aortic stenosis (AS) but little is known about ventricular dyssynchrony associated with AS. We report the case of a patient who presented AS associated with left ventricular (LV) dyssynchrony. A DSE was performed, which showed no contractile reserve but an increase in LV dyssynchrony. In this patient, the reduced aortic valve area was probably because of the association of inadequate forward stroke volume due to ischaemic cardiomyopathy and fixed severe AS. The cause of LV dysfunction may include a certain degree of intrinsic myocardial dysfunction due to ischaemic cardiomyopathy and afterload mismatch associated with dynamic LV dyssynchrony, which could be a determinant of forward stroke volume response.