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Background: In patients with severe aortic stenosis (AS) the development of symptoms plays an important role in clinical decision making. The occurrence of heart failure (HF) symptoms could be unpredictable, even in patients with normal left ventricular (LV) ejection fraction, and regardless of AS severity. The double load (valvular and vascular) imposed on the LV in AS leads to progressive LV remodeling and dysfunction and could be related to HF symptoms development.Purpose: to assess the relation between arterial mechanical properties and the presence of HF symptoms in patients with severe AS and preserved LV ejection fraction.Methods: A comprehensive echocardiogram was performed in 36 consecutive patients (73±11 years, 20 men) with severe AS (aortic valve area, AVA = 0.47±0.13 cm2) and preserved LV ejection fraction (66±10%). Carotid stiffness index (beta) was measured by a real time echo-tracking system. Aortic beta index was calculated based on systolic and diastolic ascending aorta diameters and systolic and diastolic arterial blood pressure. Systemic arterial compliance (SAC) and valvulo-arterial impedance (Zva) were also determined. Global longitudinal strain (GLS) was assessed from the apical views using a commercially available 2D Strain software. Patients were divided into two groups according to the presence (18 patients) or absence (18 patients) of HF symptoms.Results: Carotid beta index (11.9±4.4) was significantly correlated with aortic beta index (13.5±6.3)(r=0.78, p<0.001) and SAC (r=-0.37, p=0.03) but not with Zva or AS severity indices (p>0.05 for all). Symptomatic patients were older (79±8 years vs 67±11 years, p=0.001), had higher values for carotid beta index (p=0.004), aortic beta index (p=0.01), LV mass index (p=0.003), E/E' (p=0.003) and logBNP (p=0.01) and lower values for GLS (p=0.001) than asymptomatic patients. There were no significant differences between groups with respect to AS severity indices, Zva or SAC. Receiver operating characteristic curve analysis confirmed that carotid beta index, E/E', GLS and logBNP, all provide incremental information (area under the curve = 0.75, 0.81, 0.78, 0.76, p<0.05 for all) in distinguishing patients with HF symptoms.Conclusion: In patients with severe AS and preserved LV ejection fraction, increased arterial stiffness correlates with HF symptoms. The automatic measurement of carotid beta index, using an echo-tracking system, could be an useful additional tool for identification and follow-up of patients at risk for HF symptoms development.