Multidirectional myocardial function in bicuspid aortic valve stenosis patients: a three-dimensional speckle tracking...

Area of Science:

• Cardiology
• Echocardiography
• Cardiac Mechanics

Background:

• Bicuspid aortic valve (BAV) is linked to early left ventricular longitudinal myocardial dysfunction, even with normal valve function.
• The impact of aortic stenosis (AS) severity on multidirectional myocardial function in BAV patients is not fully understood.

Purpose of the Study:

• To evaluate multidirectional myocardial functions in BAV patients across varying AS severities.
• To assess the relationship between AS severity and myocardial function in BAV.

Main Methods:

• Included 86 BAV patients (normal function, mild, moderate, severe AS) and 30 controls.
• Utilized 3D speckle tracking echocardiography (3D-STE) for multidirectional strain and volume analysis.
• Preserved left ventricular ejection fraction (LVEF ≥ 52%) was maintained in all BAV groups.

Main Results:

• Global longitudinal strain (GLS) and global radial strain (GRS) were reduced in BAV patients compared to controls.
• Progressive impairment of GLS and GRS was observed with increasing AS severity (P < 0.001).
• Global circumferential strain (GCS) decreased significantly from moderate AS onwards; indexed aortic valve area (AVA/BSA) independently predicted GLS, GCS, and GRS.

Conclusions:

• Left ventricular longitudinal function is reduced even in BAV patients with normally functioning valves.
• Increasing AS severity progressively impairs longitudinal myocardial function in BAV.
• Circumferential function is affected from moderate AS, and AVA/BSA is a key determinant of multidirectional myocardial dysfunction.