Can Two-Dimensional Speckle Tracking Imaging Detect the Myocardial Fibrosis in Aortic Stenosis Patients?

Introduction: Determining the appropriate timing of intervention is critical and clinically complex in the management of aortic stenosis (AS). An early intervention may be justified in case of subclinical systolic dysfunction in patients with preserved LVEF. Positive gadolinium delayed enhancement (GdDE) by MRI is a marker of myocardial fibrosis and reported to be a negative prognostic factor. The aim of this study was 1) to assess the myocardial fibrosis using GdDE in AS with preserved EF, and 2) to test the diagnostic value of longitudinal strain to detect myocardial fibrosis. Methods: Thirty-nine patients with moderate or severe AS were prospectively enrolled. Previous myocardial infarction, presence of wall motion asynergy, greater than mild valvular regurgitation, any known cardiomyopathy, EF<50%, and age<65 were excluded. Patients had cardiac MRI and were assessed presence or absence of GdDE, and had comprehensive echocardiography examinations. Global longitudinal strain (GLS) and regional longitudi...