Key result
Normal-functioning bicuspid aortic valves and increased pulse wave velocity were independently associated with higher global wasted work (ß=8.4 and ß=5.6, respectively) compared to healthy controls.
Why the study?
Data on left ventricular abnormalities in normo-functional bicuspid aortic valve disease are scarce, and the impact of afterload and involved mechanisms remains unclear.
Does isolated normo-functioning bicuspid aortic valve and increased arterial stiffness impair left ventricular myocardial work indices compared to healthy controls?
Cross-Sectional (n=82)
No
Does isolated normo-functioning bicuspid aortic valve and increased arterial stiffness impair left ventricular myocardial work indices compared to healthy controls?
Answers are grounded in this paper and cite their sources.
In asymptomatic patients with normo-functioning bicuspid aortic valves, increased arterial stiffness is independently associated with higher global wasted myocardial work, suggesting a mechanism for subclinical myocardial dysfunction.
Objective Data related to the existence of left ventricular (LV) abnormalities in normo-functional bicuspid aortic valve (BAV) disease is scarce. Also, the impact of afterload and the involved mechanisms are unclear. In this work, we study the relationship between LV function assessed with myocardial work index (MWI) and arterial stiffness in a cohort of normo-functioning BAV patients. Methods In this study, we included a total of 38 consecutive patients with isolated BAV and 44 age- and gender-matched control subjects with tricuspid aortic valve (TAV). All participants underwent transthoracic echocardiography (TTE) to assess conventional parameters, global longitudinal strain (GLS), and MW by non-invasive left ventricular pressure–strain loop (LV-PSL) method. The aortic pulse wave velocity(PWV) was used to determine arterial stiffnessand wave reflection was evaluated by applanation tonometry. Results The mean aortic PWV was significantly higher in BAV patients (6.4 ± 0.80, 7.02 ± .1.2, p = 0.01, respectively). The statistical difference was not significant for the parameters linked to LV-MW, such as global work index (GWI) and global constructive work (GCW) between the BAV and control groups (1969 ± 259 and 2014 ± 278, p = 0.45; 2299 ± 290 and 2359 ± 345, p = 0.39 respectively). In contrast, the BAV and control groups were significantly different in terms of global work efficiency (GWE) (96.26 ± 1.69 and 97.05 ± 1.27, p = 0.02) and global wasted work (GWW) ; (78.2 ± 32.1 and 61.8 ± 24.4, p = 0.01,). Multivariable ordinary least square (OLS) regression analysis for predicting GWW demonstrated that BAV increased GWW (ß=8.4; 95% CI: 1.5–15.3; p = 0.04) and PWV increased GWW (ß=5.6; 95% CI: 0.7–10.5; p = 0.01). Conclusion The results of the MW analysis in this study revealed that the GWE values were lower and the GWW values were higher. Also, PWV had a significant impact on MW and it was independently associated with GWW. The association between aortic PWV and GWW may help to explain the documented mechanism of subclinical myocardial dysfunction in isolated BAV patients.
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Toprak et al. (2022) conducted a cross-sectional in Isolated Bicuspid Aortic Valve (n=82). Bicuspid Aortic Valve vs. Tricuspid Aortic Valve was evaluated on Global Wasted Work (GWW) (ß=8.4, 95% CI 1.5-15.3, p=0.04). Normal-functioning bicuspid aortic valves and increased pulse wave velocity were independently associated with higher global wasted work (ß=8.4 and ß=5.6, respectively) compared to healthy controls.
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