Symptoms in severe aortic stenosis are associated with decreased compensatory circumferential myocardial mechanics

Shemy Carasso, Diab Mutlak, Jonathan Lessick, Shimon A. Reisner, Harry Rakowski, Yoram Agmon

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Background: Symptomatic patients with severe aortic stenosis (AS) demonstrate abnormal left ventricular (LV) mechanics. The aim of this study was to compare mechanics in asymptomatic and symptomatic patients with severe AS using two-dimensional myocardial strain imaging. Methods: One hundred fifty-four patients with severe AS (aortic valve area ≤ 1.0 cm2) referred to a heart valve clinic from 2004 to 2011 were studied. Thirty patients were asymptomatic, with normal LV ejection fractions (≥55%), without other significant valvular disease or wall motion abnormalities. Thirty-two symptomatic patients who underwent early aortic valve replacement, with similar age, gender, LV ejection fraction, and aortic valve area, were selected for comparison. Both groups were also compared with 32 healthy subjects with similar age and gender distributions and normal echocardiographic results who served as controls. LV longitudinal and circumferential strain and rotation were measured using speckle-tracking software applied to archived echocardiographic studies. Conventional echocardiographic and myocardial mechanical parameters were compared among the study subgroups. Results: Patients with asymptomatic severe AS demonstrated smaller reductions in longitudinal strain, higher (supernormal) apical circumferential strain (-38 ± 6% vs -35 ± 4%, P <.05), and extreme (supernormal) apical rotation (12.2 ± 4.9° vs 2.9 ± 1.7°, P <.0005) compared with symptomatic patients. Apical rotation < 6° was the single significant predictor of symptoms in logistic regression analysis of clinical, echocardiographic, and mechanical parameters. Twelve asymptomatic patients underwent eventual aortic valve replacement and showed decreases in strain and apical rotation compared with baseline values. Conclusions: Longitudinal strain was uniformly low in patients with severe AS and lower in those with symptoms. Compensatory circumferential myocardial mechanics (increased apical circumferential strain and rotation) were absent in symptomatic patients. Thus, myocardial mechanics may help in the follow-up of patients with severe AS and timing of valve surgery.

Original languageEnglish
Pages (from-to)218-225
Number of pages8
JournalJournal of the American Society of Echocardiography
Issue number2
StatePublished - 1 Feb 2015
Externally publishedYes

Bibliographical note

Publisher Copyright:
© 2015 American Society of Echocardiography.


  • Aortic stenosis
  • Myocardial mechanics
  • Rotation
  • Strain


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