The Interest of the Global Longitudinal Strain in Severe Valve Disease: Moroccan Experience

Amri Meriam *

Department of Cardiology Casablanca, CHU, Ibn Rochd, Morocco.

Amine Zineb

Department of Cardiology Casablanca, CHU, Ibn Rochd, Morocco.

Moufid Omar

Department of Cardiology Casablanca, CHU, Ibn Rochd, Morocco.

Habbal Rachida

Department of Cardiology Casablanca, CHU, Ibn Rochd, Morocco.

*Author to whom correspondence should be addressed.


Aims: Valvular heart diseases, primarily mitral stenosis, are a significant concern in Morocco. Early detection of left ventricular systolic dysfunction is crucial, especially in high-prevalence valvular disease populations. This study aims to investigate global longitudinal strain as a more sensitive tool for early detection, potentially providing early warning signs before a decrease in ejection fraction. Additionally, it addresses the gap in the literature, focusing on global longitudinal strain application in the Moroccan population, with a particular emphasis on mitral stenosis and aortic stenosis degenerative but also and above all rheumatic.

Study Design:  A descriptive study.

Place and Duration of Study: Cardiology department, CHU Ibn Rochd, Casablanca, Morocco, from 2020 to 2023.

Methodology: We included 81 individuals, adhering to ESC 2021 criteria, focusing on patients with pure severe mitral stenosis or severe aortic stenosis and preserved LVEF (≥50%). Excluding patients with LVEF<50%, all underwent comprehensive echocardiography, including valvular disease severity evaluation, LVEF assessment by Simpson biplane, and global longitudinal strain, with descriptive analysis conducted using Excel.

Results: 51.9% of our patients had severe mitral stenosis, and 48.1% had severe aortic stenosis. Mitral stenosis was mainly rheumatic and aortic stenosis was mainly degenerative.  The global longitudinal strain was the lowest for mitral stenosis with -14.95%, and -15.25% for aortic stenosis.

Conclusion: Our Moroccan experience has underscored the significance of global longitudinal strain in assessing valvular heart disease cases with preserved ejection fraction. Our specific focus on mitral stenosis, highly prevalent in our population and exhibiting the most pronounced global longitudinal strain impairment, underscores the value of routine global longitudinal strain measurements in valve disease evaluation, particularly in mitral stenosis. Ongoing patient monitoring will further contribute to prospective, conclusive insights into mitral stenosis management.

Keywords: Global longitudinal strain, valvular disease, mitral stenosis

How to Cite

Meriam , Amri, Amine Zineb, Moufid Omar, and Habbal Rachida. 2024. “The Interest of the Global Longitudinal Strain in Severe Valve Disease: Moroccan Experience”. Asian Journal of Cardiology Research 7 (1):7-12.


Download data is not yet available.


Ozdemir AO, Kaya CT, Ozcan OU, Ozdol C, Candemir B, Turhan S. et al. Prediction of subclinical left ventricular dysfunction with longitudinal two-dimensional strain and strain rate imaging in patients with mitral stenosis. The international Journal of Cardiovascular Imaging. 2010; 26(4):397–404 Available:

Shantanu P, Sengupta, Makoto Amaki, Manish Bansal, Mahesh Fulwani, Sunil Washimkar et al. Effects of percutaneous balloon mitral valvuloplasty on left ventricular deformation in patients with isolated severe mitral stenosis: A speckle-tracking strain echocardiographic study. Journal of the American Society of Echocardiography. 2014;27(6): 639-647 Available:

Taamallah K, Jabloun TY, Guebsi M, Hajlaoui N, Lahidheb D, Fehri W. Subclinical right ventricular dysfunction in patients with mitral stenosis. J Echocardiogr. 2022;20(2):87-96. DOI: 10.1007/s12574-021-00554-5

Rudiktyo E, Soesanto AM, Cramer MJ, Yonas E, Teske AJ, Siswanto BB, Doevendans PA. Global left ventricular myocardial work efficiency in patients with severe rheumatic mitral stenosis and preserved left ventricular ejection fraction. J Cardiovasc Imaging. 2023;31(4):191-199. DOI: 10.4250/jcvi.2022.0124

Cvijic M, Voigt JU. Application of strain echocardiography in valvular heart diseases. Anatolian journal of cardiology. 2020;23(5):244–253. Available:

Vollema EM, Sugimoto T, Shen M, Tastet L, Ng ACT, Abou R, et al. Association of left ventricular global longitudinal strain with asymptomatic severe aortic stenosis: Natural course and prognostic value. JAMA Cardiology. 2018;3(9):839–847. Available:

Saijo Y, Isaza N, Conic JZ, Desai MY, Johnston D, Roselli EE, Grimm RA, Svensson LG, Kapadia S, Obuchowski NA, Griffin BP, Popović ZB. Left ventricular longitudinal strain in characterization and outcome assessment of mixed aortic valve disease phenotypes. JACC Cardiovasc Imaging. 2021;14(7):1324-1334. DOI: 10.1016/j.jcmg.2021.01.020

Liao H, Yang S, Yu S, Hu X, Meng X, Wu K. Prognostic value of left ventricular global longitudinal strain for major adverse cardiovascular events in patients with aortic valve disease:A meta-analysis. Cardiology; 2024. DOI: 10.1159/000536331

D'Andrea A, Carbone A, Agricola E, Riegler L, Sperlongano S, Tocci G, et al. Predictive value of left ventricular myocardial deformation for left ventricular remodeling in patients with classical low-flow, low-gradient aortic stenosis undergoing transcatheter aortic valve replacement. Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography. 2019;32(6): 730–736.

Bijvoet GP, Teske AJ, Chamuleau SAJ, Hart EA, Jansen R, Schaap J. Global longitudinal strain to predict left ventricular dysfunction in asymptomatic patients with severe mitral valve regurgitation: literature review. Neth Heart J. 2020;28(2): 63-72. DOI: 10.1007/s12471-019-01318-8

Ueyama H, Kuno T, Takagi H, Krishnamoorthy P, Prandi FR, Palazzuoli A, Sharma SK, Kini A, Lerakis S. Prognostic value of left ventricular global longitudinal strain in mitral regurgitation: a systematic review. Heart Fail Rev. 2023;28(2):465-483. DOI: 10.1007/s10741-022-10265-3 Epub 2022 Jul 28.