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Prognostic implications of left ventricular global longitudinal strain in patients with bicuspid aortic valve disease

William K F Kong1,2, E Mara Vollema1, Francesca Prevedello1

  • 1Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC Leiden, The Netherlands.

European Heart Journal. Cardiovascular Imaging
|October 22, 2019
PubMed

Insights

Impaired left ventricular global longitudinal strain (GLS) is common in bicuspid aortic valve (BAV) patients with normal ejection fraction and predicts adverse events like aortic valve replacement.

Area of Science:

  • Cardiology
  • Echocardiography
  • Valvular Heart Disease

Background:

  • Bicuspid aortic valve (BAV) is a common congenital heart defect.
  • Left ventricular (LV) ejection fraction (EF) is often preserved in BAV patients.
  • Prognostic implications of impaired LV global longitudinal strain (GLS) in BAV with preserved LVEF are not well understood.

Purpose of the Study:

  • To evaluate the frequency and prognostic significance of impaired LV GLS in patients with BAV and preserved LVEF.
  • To assess the association between LV GLS and cardiovascular events in this population.

Main Methods:

  • A cohort of 513 BAV patients with preserved LVEF (>50%) was analyzed.
  • Patients were categorized based on BAV dysfunction severity (normal, mild AS/AR, moderate/severe isolated AS, moderate/severe isolated AR, moderate/severe mixed AS/AR).
  • LV GLS was measured using 2D speckle-tracking echocardiography, with impaired function defined as LVGLS ≤ -13.6%.

Main Results:

  • The prevalence of impaired LV GLS varied across BAV dysfunction groups, being highest in normal BAV (97%) and lowest in moderate/severe mixed AS/AR (79%).
  • Over a median of 10 years, 41% underwent aortic valve replacement and 3% died.
  • Impaired LV GLS (>-13.6%) was independently associated with a significantly higher risk of adverse events, primarily aortic valve replacement (HR 1.09, P<0.001).

Conclusions:

  • Impaired LV GLS is a frequent finding in BAV patients with preserved LVEF.
  • LV GLS is an independent predictor of adverse cardiovascular events, including aortic valve replacement, in this patient group.
Abstract

Keywords:
bicuspid aortic valveglobal longitudinal strainprognosis

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