Abstract
Bicuspid aortic valve (BAV) is monitored by transthoracic echocardiography and computed tomography (CT) angiography. However, it does not have any early marker of disease progression. This study evaluated speckle-tracking echocardiography (STE) aortic and left ventricular (LV) strain prognostic values, their discriminative power, and their correlation with the degree of valvular regurgitation. We conducted a retrospective analysis of a prospectively enrolled cohort of 45 diagnosed with BAV and 20 gender and age matched controls. We performed 2D-STE aortic and LV strain analysis of the selected population. The cohort was followed-up during a median period of 19.9 months (IQR 12.9-25.2), and outcomes (hospital admission for heart failure (HF), aortic valve replacement (AVR), and death) were determined. The mean patient age was 46.6 ± 15.5 years and 80 % were male. LV indexed volumes and aortic diameter were higher in BAV patients. LV global longitudinal strain (GLS) was impaired (p < 0.001) and aortic GLS was significantly augmented (p = 0.027) in BAV patients. Aortic global circumferential strain (GCS) did not vary between groups. Aortic diameter was the best parameter related to BAV (AUC 0.92) and aortic GLS was best correlated with significant AR (AUC 0.76). AVR was the only outcome observed and its only predictor was indexed LV end-diastolic volume. BAV had impaired LV-GLS values. Aortic GLS was abnormally augmented in BAV patients, which might reflect higher aortic diameters that distorted strain calculations. STE aortic strain is related to AR but does not appear to be a reliable predictor of surgery in BAV patients, at 19 months.
Highlights
Bicuspid aortic valve (BAV) is the most common congenital heart disease [1,2,3,4] and it is present at birth in approximately 1–2 % of the global population [5, 6]
After excluding patients with left ventricular ejection fraction (LVEF) < 50 %, age < 18 years, wall-motion abnormalities, aortic stenosis and poor acoustic window, a total of 45 patients with BAV and 20 controls were included in our study
We observed that aortic dimension was the best parameter associated with BAV disease and that LVEDVi was the main predictor of time to surgery in BAV patients
Summary
Bicuspid aortic valve (BAV) is the most common congenital heart disease [1,2,3,4] and it is present at birth in approximately 1–2 % of the global population [5, 6]. It has a male predominance of 3:1 [7] and it is widely accepted to occur due to. It can be categorized in Sievers 0–2 according to the number of raphes present in the fused cusp [11]
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