Aortic stenosis: don’t grade severity from AVA alone. Echo assessment of AS should be integrative. For severe AS, the classic concordant parameters are: 🔵 Vmax ≥4.0 m/s ⚪ Mean gradient ≥40 mmHg 🔴 AVA ≤1.0 cm² ⚫ Indexed AVA ≤0.6 cm²/m² can support severe AS, particularly in patients with small body size. ( But what if the numbers disagree) That is where the real echocardiographic reasoning begins. 1️⃣ First, check for measurement error, especially LVOT diameter, LVOT VTI and Doppler alignment. 2️⃣ Then assess flow status: Low flow: SVi ≤35 mL/m² A patient with AVA ≤1.0 cm² and mean gradient <40 mmHg may have low-flow, low-gradient AS, with interpretation depending on LVEF and the clinical context. In selected discordant cases, CT assessment of aortic valve calcification can provide important additional evidence of stenosis severity. The 2025 ESC/EACTS guidelines emphasize multimodality assessment when severity remains uncertain. #Echocardiography #Cardiology #AorticStenosis #ASE