Tissue Doppler imaging (TDI) has improved the ability to detect subclinical changes in left ventricular (LV) function. The aim of this study was to investigate if asymptomatic patients with moderate aortic stenosis (AS) had impaired LV systolic and diastolic function. Fifty patients (mean age 65 +/- 12 years) recruited into the multicenter Simvastatin + Ezetimibe in Aortic Stenosis (SEAS) study with aortic peak velocities of 2.5 and 4.0 m/s were compared with 26 healthy subjects (mean age 64 +/- 12 years) (p = NS). Peak systolic tissue velocities and strain were measured at 8 LV locations and averaged. Early diastolic tissue velocity from the septal mitral annulus (E'sep) was measured as an index of LV relaxation. The ratio of early diastolic transmitral pulsed Doppler (E) to E'sep (E/E'sep) was calculated as an index of LV filling pressure. Peak systolic tissue velocity (4.1 +/- 1.0 vs 4.8 +/- 1.1 cm/s, p <0.01) and strain (-16.6 +/- 2.7% vs -17.9 +/- 2.0%, p <0.05) were decreased in patients with AS compared with controls. E'sep was decreased (4.9 +/- 1.0 vs 5.8 +/- 1.3 cm/s, p <0.01) and E/E'sep was increased (17.4 +/- 9.7 vs 11.7 +/- 3.8, p <0.01) in the AS group compared with the control group. In conclusion, asymptomatic patients with moderate AS have impaired LV systolic function as measured by reduced peak systolic tissue velocity and strain. Augmented LV filling pressure measured by E/E'sep and impaired LV relaxation measured by reduced E'sep also indicate diastolic dysfunction in these patients.