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Objectives: In moderate to severe aortic stenosis (AS), increase in left ventricular (LV) afterload induces changes in LV geometry in order to preserve LV ejection fraction (EF). Detecting subtle changes in LV myocardium before irreversible systolic deterioration develops is important. The aim of this study was to evaluate subclinical LV systolic dysfunction by using velocity vector imaging (VVI) based strain imaging, and its relation to LV geometry, in patients with moderate to severe AS and normal LV EF.Methods: We studied 40 patients with moderate to severe AS (72.08±11.14 years and 63 % male) and 30 sex and age matched healthy controls.Conventional echocardiography and VVI- based strain imaging were performed to analyze LV systolic function.We also measured LV mass index and relative wall thickness. To evaluate LV longitudinal systolic function, segmental peak systolic strain (S) and strain rate (SRs) data were acquired from apical four chamber, two chamber and long axis views.Results: Longitudinal peak systolic S and SR of the LV were significantly decreased in patients with AS, compared to controls (strain: 12.95 ± 0.44 to 23.73 ±0.34, p=0.0001 and SRs: 0.43 ± 0.20 to 4.94 ± 0.55, p=0.0001). LV strain and strain rate values were negatively correlated with LV geometry indices; LV mass index (r=-0.645, p=0.0001 for strain; r=-0.537, p=0.0001 for strain rate) and LV relative wall thickness (r=-0.645, p=0.0001 for strain; r=-0.595, p=0.0001 for strain rate).Conclusions: Left ventricular systolic function is impaired in patients with moderate to severe AS, despite preserved LV EF. Decrease in LV strain is related to LV hypertrophy. Velocity vector imaging may be used as a novel strain imaging method for the assessment of subclinical LV dysfunction in patients with AS.