Aortic stenosis (AS) is a complex and progressive condition that can significantly reduce the quality of life and increase the incidence of premature mortality. Transthoracic echocardiography (TTE) is the gold standard imaging modality for the assessment of AS severity. While left ventricular ejection fraction (LVEF) derived from TTE is a very well-understood parameter, limitations such as high inter and intra-observer variability, insensitivity to sub-clinical dysfunction, and influence of loading conditions make LVEF a complicated and unreliable parameter. Myocardial deformation imaging has been identified as a promising parameter for identifying subclinical left ventricular dysfunction, however, this parameter is still afterload dependent. Myocardial Work is a promising novel assessment technique that accounts for afterload by combining the use of myocardial deformation imaging and non-invasive blood pressure to provide a more comprehensive assessment of mechanics beyond LVEF. This review evaluates the evidence for various echocardiographic assessment parameters used to quantify left ventricular function including myocardial work in patients with AS.

Pulmonary edema secondary to severe aortic stenosis is an emergency condition that carries a high risk of mortality and is resistant to treatment using standard heart failure therapies. We present here a patient with severe aortic stenosis, complicated by poor left ventricular function and cardiogenic shock, who has immediate hemodynamic recovery after successful balloon aortic valvuloplasty and transcatheter aortic valve implantation (TAVI) procedures. This case presentation highlights the efficacy of using the TAVI procedure in the management of severe aortic stenosis complicated by acute heart failure and cardiogenic shock with immediate improvement of hemodynamic parameters more effectively sooner after the procedure.