Shifting from Left Ventricular Ejection Fraction to Strain Imaging in Aortic Stenosis

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Medical Prognostics

Background:

• Adverse ventricular remodeling is critical in aortic stenosis (AS) progression and prognosis.
• Current guidelines use left ventricular ejection fraction (LVEF) to guide intervention timing.
• LVEF has limitations in detecting subtle myocardial damage and fibrosis.

Purpose of the Study:

• To review the role of LVEF and strain imaging in AS prognosis.
• To advocate for a shift towards strain-based assessment for risk stratification and therapeutic decisions in AS.

Main Methods:

• Review of contemporary evidence on LVEF and strain imaging in AS.
• Exploration of strain imaging's role across echocardiography, CT, and MRI.
• Analysis of strain's ability to identify subclinical myocardial dysfunction and fibrosis.

Main Results:

• Strain imaging provides insights into intramyocardial contractile force and fibrosis.
• Strain imaging can detect subclinical myocardial dysfunction missed by LVEF.
• Emerging evidence supports strain imaging in various cardiovascular modalities.

Conclusions:

• Strain imaging is a promising biomarker for assessing AS progression and guiding intervention.
• A transition from LVEF-based to strain-based strategies may improve patient outcomes in AS.
• Further research into strain imaging across different modalities is warranted for clinical application.