1 Introduction Low flow is an established risk marker in patients undergoing transcatheter aortic valve replacement (TAVR) [ 123 ]. Nonetheless, in patients with normal left ventricle function (LV), mortality rates were comparable in patients with low versus normal flow [ 1 , 2 ]. This phenomenon was evident in patients with low and high gradient severe aortic stenosis [ 1 , 2 ]. Patients with low-flow low-gradient and normal LV function are referred to as paradoxical low flow. These patients are characterized by specific pathophysiological changes accounting for the low stroke volume such as small LV cavity [ 4 ]. Importantly, echocardiographic parameters have largely taken into consideration differences between men and women, particularly in relation to LV size. Nonetheless, quantification of flow using stroke volume index uses a similar cut-off of 35 ml/m 2 regardless of sex. We sought to investigate the prognostic role of sex-specific flow threshold in patients undergoing TAVR.