Timing for aortic valve replacement (AVR) and frequency of surveillance for asymptomatic severe and moderate aortic stenosis (AS) is debated [1,2], demanding better risk-stratifying markers to guide management.

Left ventricular global longitudinal strain (LVGLS), a surrogate for myocardial fibrosis affected by arterial and valvular afterload [3], identifies subclinical myocardial damage, reflects AS progression [4], and predicts outcomes [5] better than left ventricular ejection fraction (LVEF) in asymptomatic significant AS. The prognostic value of LVGLS in AS had been studied extensively and supported by evidence [6]. Recently, with the proposed cardiac damage staging in AS [7,8], more studies have focused on the utility of left atrial strain (LAS) for risk stratification. Previous report had showed its prognostic value in asymptomatic severe AS [9] and moderated AS [10,11]. Ye et al. [12] revealed the incremental prognostic value of multi-chamber strain, including LAS, over cardiac damage staging in asymptomatic, moderate to severe AS. However, most of the studies focused on non-Asian cohort [9,10,[12], [13], [14]], leaving uncertainty about the applicability of their identified optimal cutoff in the Asian population. Furthermore, studies including patients with moderate AS are scarce and often limited by small sample sizes [[10], [11], [12], [13]].

To address the aforementioned evidence gap, our study aimed to: [1] examine the prognostic value of LAS and LVGLS in Asian population with moderate and severe AS, [2] identify the optimal LAS cutoffs for adverse events, and [3] compare post-AVR changes regarding echocardiographic parameters.