Layer-specific strain assessment of left ventricular systolic function in patients with bicuspid aortic valve

Abstract

Objective To quantitatively evaluate left ventricular (LV) systolic function in bicuspid aortic valve (BAV) using layer-specific strain (LSS). Methods Thirty BAV patients were divided into normal function (NF) group (10 cases) and non-normal function (N-NF) group (20 cases) based on aortic valvular lesion types, and 20 healthy volunteers were taken as control group. Longitudinal strain(LS) and circumferential strain (CS) of three-layer myocardium and full thickness myocardium were assessed using layer-specific speckletracking imaging, available by GE Vivid E9 and EchoPac workstation. Results There was no significant difference in left ventricular ejection fraction(LVEF) among the N-NF group, NF group and control group (P>0.05), all of them within the normal range[(63.3±7.1)%, (64.6±6.2)%, (65.3±3.9)%]. It showed a gradient decrease from the endocardium to the epicardium in both control and BAV group. LS of endocardium (LSendo) and LS of epicardium (LSepi) in N-NF group and NF group were significantly reduced compared with those in control group (P 0.05). Compared with NF group[CS: (-19.57±2.9)% vs (-13.43±2.19)% vs (-20.03±3.04)%; LS: (-21.38±2.05)% vs (-18.85±2.12)% vs (-21.09±2.03)%] and control group[CS: (-21.63±3.01)% vs (-14.34±2.55)% vs (-21.48±2.16)%; LS: (-22.18±2.30)% vs (-20.72±2.28)% vs (-22.89±2.30)%], CS[(-16.78±3.65)% vs (-11.40±3.78)% vs (-15.83±2.61)%]and LS[(-18.34±2.85)% vs (-16.08±2.68)% vs (-18.51±2.86)%] of middle myocardium, epicardial myocardium and full-thickness myocardium in N-NF group were decreased significantly (P<0.05). Conclusions It is essential to maintain normal valvular function to prevent the progress of myocardial deterioration. LSendo and LSepi can be used to sensitively identify early left ventricular systolic dysfunction in BAV patients with normal LVEF. Key words: Echocardiography; Ventricular function, left; Layer-specific strain; Bicuspid aortic valve