{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T23:55:11Z","timestamp":1781826911210,"version":"3.54.5"},"reference-count":7,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T00:00:00Z","timestamp":1780963200000},"content-version":"vor","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Computed tomography (CT) calcium scoring is used to adjudicate paradoxical low-flow, low-gradient (LFLG) severe aortic stenosis (AS). However, its reliability may be limited in rheumatic disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>An 82-year-old woman with prior mitral valve replacement for rheumatic mitral stenosis was referred for AS. Transthoracic echocardiography revealed an aortic valve area (AVA) of 0.50\u2005cm2, mean pressure gradient of 27\u2005mmHg, stroke volume index of 30\u2005mL\/m2, and preserved systolic function, suggesting paradoxical LFLG severe AS. The CT calcium score was 889 Agatston units, below the female threshold for severe AS. Three-dimensional transoesophageal echocardiography (TEE) demonstrated commissural fusion, leaflet tip thickening, and planimetry-derived AVA of 0.69\u2005cm2, confirming severe AS. The patient underwent transcatheter aortic valve implantation, with 6-min walk distance improving from 150 to 254\u2005m.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>In rheumatic morphology, low CT calcium burden may not exclude severe AS because obstruction may be driven by commissural fusion and fibrosis rather than bulky calcification. Three-dimensional TEE planimetry can serve as an anatomy-based adjudicator when echocardiographic and CT calcium findings are discordant.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytag436","type":"journal-article","created":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T10:34:13Z","timestamp":1781001253000},"source":"Crossref","is-referenced-by-count":0,"title":["A diagnostic pitfall of CT calcium scoring in paradoxical low-flow, low-gradient severe aortic stenosis with rheumatic morphology: a case report"],"prefix":"10.1093","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3566-5662","authenticated-orcid":false,"given":"Jun","family":"Yoshida","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine , 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6064-3553","authenticated-orcid":false,"given":"Toraaki","family":"Okuyama","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine , 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiromasa","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine , 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Utaro","family":"Taga","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine , 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1960-5627","authenticated-orcid":false,"given":"Michifumi","family":"Tokuda","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine , 3-25-8 Nishi-Shinbashi, Minato-ku, Tokyo 105-8461 ,","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,6,9]]},"reference":[{"key":"2026061819470065300_ytag436-B1","doi-asserted-by":"crossref","first-page":"4635","DOI":"10.1093\/eurheartj\/ehaf194","article-title":"2025 ESC\/EACTS guidelines for the management of valvular heart disease","volume":"46","author":"Praz","year":"2025","journal-title":"Eur Heart J"},{"key":"2026061819470065300_ytag436-B2","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1016\/j.echo.2017.02.009","article-title":"Recommendations on the echocardiographic assessment of aortic valve stenosis: a focused update from the European Association of Cardiovascular Imaging and the American Society of Echocardiography","volume":"30","author":"Baumgartner","year":"2017","journal-title":"J Am Soc Echocardiogr"},{"key":"2026061819470065300_ytag436-B3","doi-asserted-by":"crossref","first-page":"8019","DOI":"10.1038\/s41598-023-34118-7","article-title":"Diagnostic role of aortic valve calcium scoring in various etiologies of aortic stenosis","volume":"13","author":"Wanchaitanawong","year":"2023","journal-title":"Sci Rep"},{"key":"2026061819470065300_ytag436-B4","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1093\/ehjci\/jead142","article-title":"Influence of cusp morphology and sex on quantitative valve composition in severe aortic stenosis","volume":"24","author":"Patel","year":"2023","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2026061819470065300_ytag436-B5","doi-asserted-by":"crossref","first-page":"1516","DOI":"10.4244\/EIJ-D-19-00778","article-title":"Paradoxical low-flow, low-gradient severe aortic stenosis with mild aortic valve calcification","volume":"15","author":"Li","year":"2020","journal-title":"EuroIntervention"},{"key":"2026061819470065300_ytag436-B6","doi-asserted-by":"crossref","first-page":"6689214","DOI":"10.1155\/crp\/6689214","article-title":"Natural progression of rheumatic aortic valve disease following mitral valve intervention: a 16-year single-center experience","volume":"2025","author":"Kim","year":"2025","journal-title":"Cardiol Res Pract"},{"key":"2026061819470065300_ytag436-B7","doi-asserted-by":"crossref","first-page":"3048","DOI":"10.1016\/j.jacc.2020.04.049","article-title":"The natural history of severe calcific mitral stenosis","volume":"75","author":"Kato","year":"2020","journal-title":"J Am Coll Cardiol"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytag436\/68493481\/ytag436.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/6\/ytag436\/68493481\/ytag436.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/10\/6\/ytag436\/68493481\/ytag436.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T23:47:10Z","timestamp":1781826430000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytag436\/8704333"}},"subtitle":[],"editor":[{"given":"Christoph","family":"Sinning","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Deepti","family":"Ranganathan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,6,1]]},"references-count":7,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2026,6,1]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytag436","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,6]]},"published":{"date-parts":[[2026,6,1]]},"article-number":"ytag436"}}