Background: In patients with aortic stenosis (AS), increased afterload induces changes in
left ventricular (LV) geometry to preserve a normal ejection fraction (EF). Nevertheless, myocardial
dysfunction may occur in spite of a normal EF. Global longitudinal strain (GLS)
analysis can detect subtle contractile dysfunction at a pre-clinical stage. The aim of our study
was to assess LV function deteriorations with GLS analysis and the association with geometric
changes in patients with AS and normal EF.
Methods: Forty four patients with moderate to severe AS and 40 controls were enrolled. All
patients underwent echocardiography, including two-dimensional strain imaging. The relative
wall thickness and LV muscle mass measurements were performed with magnetic resonance
imaging and patients were subdivided into four groups: Group 1 with normal LV,
Group 2 with concentric remodeling, Group 3 with eccentric hypertrophy, and Group 4 with
concentric hypertrophy.
Results: The total group of patients with AS showed a GLS of -15.3 ± 3.6% while the control
group reached -18.9 ± 3.2% (p < 0.001). GLS was lower in the hypertrophy Groups 3 and
4 compared to Groups 1 and 2 (12.9 ± 3.4% vs 17.2 ± 2.5%, p < 0.05, respectively). Splitting
the patients into Groups 1 to 4, the GLS was -17.2 ± 2.4%, -17.2 ± 2.7%, -12.4 ± 3.8% and
-13.1 ± 3.3, respectively (p = 0.002).
Conclusions: In subjects with AS, lower GLS is related to LV hypertrophy, but not to the
presence of concentric remodeling. Assessment of GLS can identify subtle contractile dysfunction
independent of a preserved EF, and might be useful in identifying patients at high risk for
the transition from compensatory to pathological remodeling. (Cardiol J 2011; 18, 2: 151-156
