Application of left ventricular strain in patients with aortic and mitral valve disease

Left ventricular (LV) global longitudinal strain (GLS) is widely recognized as a more sensitive measure of LV systolic function compared with LV ejection fraction (LVEF). In addition, the measurement of LVGLS is more reproducible than two-dimensional LVEF. Current guidelines for diagnosis and treatment of valvular heart disease include LVEF as one of the parameters to take into consideration in the clinical decision-making. However, a large body of evidence is showing that LVGLS may be a better prognosticator than LVEF in various valvular heart diseases. In this timely state-of-the-art review, the evidence and role of LVGLS as a clinical tool in patients with aortic and mitral valve disease is appraised.

Majority of research on LVGLS and valvular heart disease focused on high-gradient aortic stenosis. Increasingly, LVGLS has also been shown to be prognostic in low-flow, low-gradient severe aortic stenosis with preserved LVEF, and in low-flow, low-gradient severe aortic stenosis with reduced LVEF. The role of LV GLS in patients with aortic regurgitation and mitral regurgitation is less well established.

LVGLS is increasingly used to identify subclinical myocardial dysfunction in patients with valvular heart disease to identify optimal timing for surgery and prognosticate outcomes after surgery.