To quantify and compare the changes in global/regional longitudinal and circumferential left ventricular strain in patients with severe aortic stenosis with preserved versus reduced ejection fraction (EF).

A total of 73 patients with severe aortic stenosis who were diagnosed and treated at the First Affiliated Hospital of Xinjiang Medical University between June 2021 and September 2024 were enrolled. The patients were divided into an EF-preserved group (n=50) and an EF-reduced group (n=23) based on an ejection fraction cutoff of 50%. A third group of 50 healthy volunteers, enrolled during the same period, served as controls. Conventional echocardiography and speckle tracking were utilized to obtain left ventricular parameters, global and regional longitudinal myocardial strain, circumferential strain, and left ventricular-arterial coupling parameters. Differences in these parameters among the three groups were evaluated using one-way ANOVA or the Kruskal-Wallis H test.

Both groups of severe aortic stenosis patients showed decreased longitudinal strain in all segments compared to the control group (P＜0.001). The reduced EF group showed decreased longitudinal strain in approximately 55% (10/18) of segments compared to the preserved EF group [basal anteroseptal segment: (-7.85±2.88)% vs (-9.47±4.37)%; mid inferoseptal segment: (-8.90±3.30)% vs (-12.74±3.24)%; mid inferior segment: (-9.23±3.37)% vs (-11.76±3.58)%; mid anterolateral segment: (-7.66±2.89)% vs (-10.05±3.12)%; apical anteroseptal segment: (-12.56±6.04)% vs (-16.17±5.11)%; apical inferoseptal segment: (-12.31±4.53)% vs (-17.62±3.57)%; apical inferior segment: (-11.71±4.01)% vs (-15.88±4.71)%; apical posterior segment: (-8.90±3.40)% vs (-13.26±4.84)%; apical anterolateral segment: (-8.91±3.83)% vs (-13.40±3.48)%; apical anterior segment: (-10.36±3.67)% vs (-13.80±7.19)%, P＜0.001]. Both groups of severe aortic valve stenosis patients showed decreased circumferential strain in all segments compared to the control group (P＜0.001). The reduced EF group showed decreased circumferential strain in approximately 83% (15/18) of segments compared to the preserved EF group [basal anteroseptal segment: (-13.61±6.08)% vs (-19.47±5.59)%; basal inferoseptal segment: (-14.60±5.30)% vs (-18.58±4.66)%; basal inferior segment: (-14.35±7.59)% vs (-19.02±5.54)%; basal posterior segment: (-14.70±6.78)% vs (-18.72±5.90)%; basal anterolateral segment: (-12.82±5.39)% vs (-16.58±4.88)%; basal anterior segment: (-14.12±6.51)% vs (-18.81±6.14)%; mid anteroseptal segment: (-14.29±7.56)% vs (-19.71±4.51)%; mid inferoseptal segment: (-15.53±6.88)% vs (-20.89±5.37)%; mid inferior segment: (-16.48±7.36)% vs (-21.70±5.32)%; mid posterior segment: (-15.80±7.75)% vs (-19.64±5.18)%; mid anterolateral segment: (-14.04±5.87)% vs (-17.69±5.62)%; apical inferoseptal segment: (-16.54±7.72)% vs (-20.71±5.17)%; apical inferior segment: (-16.06±7.75)% vs (-21.51±5.39)%; apical anterolateral segment: (-15.47±7.56)% vs (-19.79±5.59)%; apical anterior segment: (-15.49±6.99)% vs (-20.66±5.34)%; P＜0.001]. In In terms of transmural gradient strain, both longitudinal and circumferential transmural gradients were reduced in the EF-preserved group and EF-reduced group compared with the control group. Furthermore, a more pronounced reduction in the transmural gradient was observed in the EF-reduced group than in the EF-preserved group. In both groups of patients with severe aortic stenosis [EF-preserved group: 0.67 (0.62, 0.79); EF-reduced group: 1.26 (1.07, 1.68)], the left ventricular-arterial coupling index was increased compared with the control group [0.56 (0.53, 0.62)], and the increase was more significant in the EF-reduced group than in the EF-preserved group (H=78.275, P＜0.001). In patients with severe aortic stenosis, both global longitudinal strain (GLS) and global circumferential strain (GCS) showed a decreasing trend as the ejection fraction decreased. Among these, when left ventricular ejection fraction decreased from 50% to 40%, the decrease in GLS and GCS was most marked.

Compared with normal controls, the global/regional longitudinal strain and circumferential strain of the left ventricular wall are reduced in patients with severe aortic stenosis, while left ventricular-arterial coupling is elevated. In patients with reduced EF, the above strain parameters are reduced more significantly than in those with preserved EF, while the index of left ventricular-arterial coupling is further elevated.