**1. Introduction**

As the population grows older, the prevalence of aortic valve disease, particularly aortic stenosis, is swelling, making it currently, the most prevalent form of valvular heart disease [1–3]. Surgery and percutaneous interventions of the aortic valve are frequently needed in patients with severe symptomatic aortic valve disease, the timing for these procedures' conditional on a comprehensive evaluation of the dysfunctional aortic valve and the resultant repercussions on the rest of the heart, particularly the left ventricle (LV). Parameters used to predict favorable/unfavorable results from aortic valve surgery or intervention include LV ejection fraction (EF), presence and severity of left ventricular hypertrophy

(LVH), LV end-systolic volume (LVESV), degree of leaflet calcification, and trans-aortic valve gradients. Because of the LV deformation indices potential to detect subclinical LV dysfunction, they are being used with increasing frequency in the management of patients with aortic valve disease [4] and advancing the timing for aortic valve surgery or intervention, before the LV is irreversibly damaged.

Our objective with this chapter is to describe the use of strain imaging, particularly global longitudinal strain in the assessment of cardiac function in patients with aortic valve disease. We review the current clinical applications of strain analysis in patients with aortic valve disease, highlighting strengths and weaknesses and emphasizing normal and abnormal findings in aortic stenosis (AS) aortic regurgitation (AR) and mixed aortic valve disease (ASAR); we summarize unresolved issues, potential future research priorities, and recommended indications for incorporating this technique into the clinical practice of patients with aortic valve disease.
