Normal Ejection Fraction Is Associated With Severe Left Ventricular Dysfunction as Assessed by Speckle-Tracking Echocardiography:

To the Editor: I read with a great interest the study of Adda and colleagues,1 who investigated myocardial dysfunction in low flow-low gradient severe (LFLG) aortic stenosis (AS) despite preserved left ventricular ejection fraction (LVEF) by using 2D speckle-tracking echocardiog-raphy and compared severe AS patients by dividing into 4 groups, based on their flow/gradient pattern to identify their characteristics. They concluded that severe LV longitudinal dysfunction can explain LFLG despite preserved LVEF. However, results of this multicenter study have merit further discussion. Although LVEF looks apparently preserved, impaired LV mid wall fractional shortening (MWFS)2 and decreased LV global longitudinal strain (GLS) have been shown in severe AS patients. Interestingly, there is no difference between groups in terms of LV MWFS; decreased GLS and impaired LV basal deformation wer