Key result
Children with bicuspid aortic valve demonstrated significantly reduced left ventricular global longitudinal strain in the apical four-chamber view compared to controls (p=0.022).
Why the study?
BAV is a prevalent congenital heart defect challenging to manage in children, and LV GLS provides a more sensitive assessment of LV systolic function than standard LVEF.
Does speckle tracking echocardiography detect subclinical left ventricular dysfunction in paediatric patients with bicuspid aortic valve compared to controls?
Observational (n=128)
No
Does speckle tracking echocardiography detect subclinical left ventricular dysfunction in paediatric patients with bicuspid aortic valve compared to controls?
p-value: p=0.022
Speckle tracking echocardiography identifies subclinical regional left ventricular dysfunction in pediatric patients with bicuspid aortic valve despite normal ejection fraction.
Speckle tracking may detect subclinical LV dysfunction in children with BAV; hypothesis-generating and requires prospective validation before clinical adoption.
Background/Objectives: Bicuspid aortic valve (BAV) is a prevalent congenital heart defect that continues to present a significant challenge in the management of paediatric patients. The assessment of left ventricle systolic function is typically conducted through the measurement of the left ventricular ejection fraction. Currently, left ventricle global longitudinal strain (LV GLS) is regarded as a more sensitive indicator, enabling the quantitative assessment of global and segmental ventricular function through the determination of myocardial deformation. Methods: A prospective study was conducted between 10 January 2023 and 10 January 2024 in a tertiary paediatric cardiology referral centre. The study enrolled children aged 6 to 17 years with BAV who were undergoing periodic evaluation, as well as a control group. The primary objective was to analyse the systolic function (global and segmental LV) using the classical method (LV EF) and speckle tracking echocardiography (STE). Results: The study group comprised 73 patients with a mean age of 13 years and was predominantly male. The control group comprised 55 patients. The phenotype IB with aortic regurgitation (AR) was the most prevalent. The results of the STE evaluation in the control group demonstrated mean GLS values between −22.1% and −22.8%. A comparison of the BAV group and the control group revealed a significant difference in GLS for the apical four-chamber view (p = 0.022). Conclusions: Although the analysis of global LV function demonstrated normal values of EF in patients with BAV, the strain analysis revealed significantly reduced strain in the inferior segment and in the apical four-chamber view, as well as in the anterior segment. Further investigation is required to determine whether reduced LV GLS in paediatric patients with BAV will ultimately result in the development of clinical heart failure. Additionally, it is necessary to ascertain whether this can identify patients with subclinical heart failure and whether early detection can result in a reduction in morbidity.
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Făgărășan et al. (2024) conducted an observational in Bicuspid aortic valve (BAV) (n=128). Bicuspid aortic valve (BAV) vs. Control group was evaluated on Systolic function (global and segmental LV) using LV EF and speckle tracking echocardiography (STE) (p=0.022). Children with bicuspid aortic valve demonstrated significantly reduced left ventricular global longitudinal strain in the apical four-chamber view compared to controls (p=0.022).
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