The objective of this study was to examine the value of stress-echocardiography in patients with paradoxical low-flow, low-gradient (PLFLG) aortic stenosis (AS). The projected aortic valve area (AVA_Proj) at a normal flow rate was calculated in 55 patients with PLFLG AS. In the subset of patients (n = 13) who underwent an aortic valve replacement within 3 months after stress echocardiography, AVA_Proj correlated better with the valve weight compared to traditional resting and stress echocardiographic parameters of AS severity (AVA_Proj: r = −0.78 vs. other parameters: r = 0.46 to 0.56). In the whole group (N = 55), 18 (33%) patients had an AVA_Proj >1.0 cm², being consistent with the presence of pseudo severe AS. The AVA_Proj was also superior to traditional parameters of stenosis severity for predicting outcomes (hazard ratio: 1.32/0.1 cm² decrease in AVA_Proj). In patients with PLFLG AS, the measurement of AVA_proj derived from stress echocardiography is helpful to determine the actual severity of the stenosis and predict risk of adverse events.