Rodriguez-Gabella T, et al. - Researchers assessed the clinical outcomes and treatment futility in patients with paradoxical low-flow (PLF), low-gradient (LG) severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). Treatment futility was defined as death or poor functional status (NYHA class III/IV) at 6-month follow-up. Patients were divided in two groups: high gradient AS group (HG-AS; mean gradient ≥ 40mmHg and stroke volume index > 35ml/m²); and paradoxical low-flow, low-gradient AS group (PLF-LG-AS; mean AV gradient <40mmHg and indexed stroke volume ≤ 35ml/m²). In one-fourth of patients with PLF-LG-AS, the futility of TAVI was evident as a treatment option. The complexity and need for improving the clinical decision-making process and management of patients with PLF-LG-AS were highlighted.