It has been suggested that myocardial systolic deformation parameters may be a more sensitive marker of left ventricular (LV) systolic dysfunction than LV ejection fraction (LVEF). However, its prognostic value in patients with aortic stenosis (AS) remains debated.

In an ongoing prospective cohort of asymptomatic patients with at least mild, pure, isolated AS, global longitudinal strain (GLS) was measured at baseline using 2D speckle tracking imaging, and AS related events (occur-rence of symptoms, congestive heart failure and sudden death) were prospectively collected.

We prospectively enrolled 176 patients (mean age 72 years, 70% male). Mean aortic valve area was 1.25cm2and mean gradient 28.8mmHg. Overall, 88 patients had mild AS, 50 patients moderate AS and 38 patients severe AS. During a mean follow up period of 2.2 years, 38 events occurred. GLS was not correlated to pic velocity, mean gradient or aortic valve area (AVA) (all p>0.05). In univariate analysis, neither in the whole cohort (p=0.75), nor in the subgroup of moderate/severe AS, GLS was predictive of future AS related events. Results were unchanged after adjustment for AS hemodynamic severity (p=0.66 and p=0.82, respectively).

Our data suggest that longitudinal strain assessed by 2D speckle tracking echocardiography, is not predictive of future symptomatic status in asymptomatic patients with AS and preserved LVEF. Thus, this index should not be recommended in daily practice, in order to select patients who should undergo an early aortic valve replacement.