Bicuspid Aortic Valve With Preserved Ejection Fraction: One-Year Changes in Ventricular and Atrial Mechanics

Left ventricular (LV) dysfunction in bicuspid aortic valve (BAV) disease may precede ejection fraction (EF) decline. We assessed 1-year changes in LV global longitudinal strain (GLS), left atrial (LA) strain and myocardial work in BAV with preserved EF.

This retrospective cohort included 82 adults with BAV and sinus rhythm who had preserved LVEF (≥50%) at two echocardiograms 363 ± 15 days apart without interim surgery; 40 age- and sex-matched controls with tricuspid aortic valves were imaged once. Primary outcomes were changes in absolute GLS and LA reservoir strain (LASr); myocardial work, corrected for the transaortic gradient in aortic stenosis, was exploratory. Reader reproducibility was tested on stored images.

At baseline, patients had lower absolute GLS (17.8 ± 2.8% vs. 21.8 ± 1.0%) and LASr (38.5 ± 5.2% vs. 40.8 ± 3.4%) than controls (p < 0.001 and p = 0.004). At 1 year, mean LVEF and LV volumes did not change significantly, whereas absolute GLS decreased by 0.8% points (95% CI 0.5-1.1) and LASr by 2.4 points (1.7-3.0; both Holm-adjusted p < 0.001). Gradient-corrected global work index decreased by 47 mmHg% (27-68). The GLS decrease exceeded the intra-observer minimal detectable change in 22 patients (27%), versus an increase in 4 (5%). The GLS change was not significantly associated with valve lesion type or severity.

In selected patients with BAV who maintained preserved LVEF without valve or aortic surgery, LV GLS and LA reservoir strain decreased slightly over 1 year. Their clinical significance requires validation with longitudinal controls and test-retest data.