Clinical Applications of Strain Imaging in Aortic Valve Disease

The prevalence of aortic valve disease, particularly aortic stenosis, is increasing in parallel to the aging of the population, making it the most prevalent form of valvular heart disease. Surgery and percutaneous interventions of the aortic valve are conditional to a comprehensive evaluation of the aortic valve and the left ventricle (LV). Favorable results from aortic valve surgery or intervention are influenced by LV ejection fraction (EF), presence and severity of left ventricular hypertrophy (LVH), LV end-systolic volume (LVESV), degree of leaflet calcification, and trans-aortic valve gradients. Deformation imaging, particularly global longitudinal strain, is evolving as a powerful tool in the evaluation of ventricular function in patients with aortic stenosis. GLS is particularly suited to detect subclinical LV dysfunction, before a drop in LV ejection fraction, providing the opportunity to intervene earlier to prevent serious and permanent LV dysfunction. Similar added value has been demonstrated in the application of GLS in the detection of subclinical LV dysfunction in patients with aortic regurgitation. Very little information exists in the use of GLS in patients with mixed aortic valve disease, providing an opportunity for future research in this important group of patients with aortic valve disease.