Key result
LA and LV strain do not differ by severity or hypertrophy in pediatric congenital AS.
Why the study?
Left ventricular and left atrial strain have prognostic value and clinical relevance in adults with aortic stenosis, but their role in children with congenital aortic stenosis is unclear.
Does myocardial deformation (LA and LV strain) worsen with higher gradients or greater ventricular mass in children with congenital aortic valve stenosis?
Cross-Sectional (n=84)
Does myocardial deformation (LA and LV strain) worsen with higher gradients or greater ventricular mass in children with congenital aortic valve stenosis?
In children with congenital aortic stenosis and preserved systolic function, LA and LV strain are preserved across disease severity and hypertrophy categories, indicating an absence of adverse ventricular remodeling prior to intervention.
Answers are grounded in this paper and cite their sources.
Preserved LA/LV strain across severity in pediatric congenital AS suggests absent early remodeling; leaves open deformation imaging's role in pre-intervention monitoring.
Left ventricular (LV) longitudinal strain (LS) has prognostic value in adults with valvar aortic stenosis (AS), and impaired left atrial (LA) strain is associated with elevated filling pressures. The role of LA and LV strain in children with congenital AS is unclear. We hypothesized that LA and LV strain would be worse with higher gradients and/or greater ventricular mass. We performed a retrospective cross-sectional study (2015–2025) of children aged 1–18 years with isolated congenital AS and preserved systolic function, stratified by Doppler-derived mean gradient as mild (<20 mmHg), moderate (20–40 mmHg), or severe (>40 mmHg). Patients with critical neonatal AS, more than mild aortic regurgitation, prior intervention, genetic syndromes, or inadequate image quality were excluded. LA reservoir, conduit, and contraction strain and LV LS were measured by two-dimensional speckle-tracking echocardiography. Group comparisons and correlation analyses evaluated associations with aortic valve gradient, LV mass index, and mitral E/A ratio. Eighty-four children were identified (mean age 8.7 ± 4.6 years; 33% female). LA strain components (all p >0.2) and LV LS ( p =0.8) did not differ across AS groups. Stratification by LV mass Z score (≤2 vs. >2) showed no differences in LA or LV strain. No strain parameter correlated with aortic valve gradient, LV mass index, or mitral E/A ratio (all p >0.05). In children with congenital AS, preserved systolic function, and no prior intervention, LA and LV strain are preserved across disease severity and ventricular hypertrophy categories, suggesting preserved myocardial function and absence of adverse ventricular remodeling.
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Abdulkarim et al. (2026) conducted a cross-sectional in Isolated congenital aortic stenosis (n=84). Congenital aortic stenosis severity (aortic valve gradient and LV mass) vs. Comparisons across mild, moderate, and severe gradients was evaluated on Left atrial (LA) and left ventricular (LV) longitudinal strain (p=>0.2 for LA strain, 0.8 for LV LS). In children with congenital aortic stenosis, left atrial and left ventricular strain did not differ across disease severity groups (p>0.2 and p=0.8, respectively) or ventricular hypertrophy categories.
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