Myocardial Deformation Analysis in Congenital Aortic Valve Stenosis: Comparison Across Clinical Phenotypes in Children.

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.