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Figure 2 Longitudinal Left Ventricular Mechanics in Asymptomatic Severe Aortic Stenosis

Continuous wave Doppler signal across the stenotic aortic valve (A) shows a peak and mean gradient of 80 and 44 mm Hg, respectively. Pulsed wave tissue Doppler from the septal corner of the mitral valve annulus (B) shows a reduced peak early diastolic longitudinal relaxation velocity (5 cm/s). Longitudinal strain obtained by speckle tracking (2D strain, GE Healthcare, Milwaukee, Wisconsin) shows attenuated peak longitudinal strain (C and D) from apical (green curve), mid (yellow curve), and basal (blue curve) of the lateral wall of the left ventricle (peak strain values <10%). Dotted white line (D) also shows a reduced global longitudinal strain averaged from the septum and lateral wall of the left ventricle (global strain = 12%). Aa = peak late diastolic annular velocity; Ea = peak early diastolic annular velocity; Sa = peak systolic velocity during ejection.