Backward Aortic Flow Is Associated with Impaired Left Ventricular Mechanics in Young Adults with Bicuspid Aortic Valve: A Prospective Cardiovascular Magnetic Resonance Study

Q: What are the key findings of this study?

Young adults with bicuspid aortic valve exhibited impaired left ventricular global longitudinal strain (-19.7% vs -21.2%) and a significantly greater backward-flow burden compared to healthy controls.

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Bicuspid aortic valve (n=112). Intervention: Bicuspid aortic valve vs. Healthy volunteers. Primary outcome: Left ventricular global longitudinal strain (LV-GLS) (p=<0.001).

Q: What does this research mean for the field?

In young adults with bicuspid aortic valve, increased backward aortic flow burden is significantly associated with impaired subclinical left ventricular mechanics and increased aortic stiffness, despite preserved ejection fraction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

Characterize aortic flow abnormalities and determine their associations with aortic geometry and ventricular mechanics using cardiovascular magnetic resonance in young adults with bicuspid aortic valve.

Oana Iulia Man; Rares Ilie Orzan; Dalma Horvat; Renata Agoston; Andra Negru; Cecilia Lazea; Silvia Lupu; Lucia Agoşton-Coldea

doi:10.3390/jcm15176828

September 3, 2026Journal of Clinical MedicineOpen Access

Backward Aortic Flow Is Associated with Impaired Left Ventricular Mechanics in Young Adults with Bicuspid Aortic Valve: A Prospective Cardiovascular Magnetic Resonance Study

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Key result

Bicuspid aortic valve in young adults is linked to impaired LV-GLS and higher backward-flow burden.

P<0.001
n=112

Figures

Why the study?

BAV alters transvalvular flow and increases shear stress on the ascending aorta, but the associations between aortic flow abnormalities, aortic geometry, and ventricular mechanics required characterization using CMR.

Key Points

Characterize aortic flow abnormalities and determine their associations with aortic geometry and ventricular mechanics using cardiovascular magnetic resonance in young adults with bicuspid aortic valve.
Conducted a prospective cross-sectional cardiovascular magnetic resonance study evaluating 56 young adults with confirmed bicuspid aortic valve and 56 age- and sex-matched healthy controls (median age 25 years in both groups).
Quantified biventricular volumes and function, left ventricular global longitudinal strain (LV-GLS), left ventricular torsion, ascending aortic dimensions, pulse-wave velocity, aortic distensibility, and phase-contrast-derived forward and backward flow parameters.
Compared to controls, patients with bicuspid aortic valve had preserved left ventricular ejection fraction (65.7 ± 7.7% vs. 65.8 ± 6.0%; p = 0.343) but significantly impaired LV-GLS (−19.7 ± 1.31% vs. −21.2 ± 1.92%; p < 0.001) and reduced global left ventricular torsion (1.59 ± 0.22 vs. 1.96 ± 0.27°/cm; p < 0.001).
Patients with bicuspid aortic valve exhibited higher peak backward-to-forward flow-rate ratios (21.40 ± 9.2% vs. 14.49 ± 6.3%; p < 0.001) and total backward-flow volume (16.70 ± 11.4 vs. 9.59 ± 4.4 mL; p = 0.001) despite similar net aortic flow (59.69 ± 17.0 vs. 62.04 ± 19.1 mL; p = 0.494).
In multivariable linear regression explaining 52% of backward-flow burden variability (R² = 0.52; p < 0.001), LV-GLS (β = 0.469 ± 0.229; p = 0.0271) and aortic regurgitant volume (β = 0.173 ± 0.049; p = 0.0381) were independently associated with the peak backward-to-forward flow-rate ratio.

Study Design

Type

Cross-Sectional (n=112)

Blinding

Observers blinded to clinical and echocardiography data

Multicenter

No

Structured PICO

P

Population

112 young adults (median age 25, 37% female), comprising 56 with bicuspid aortic valve and 56 healthy matched controls, underwent cross-sectional cardiovascular magnetic resonance imaging.

C

Comparator

56 age- and sex-matched healthy volunteers with no clinically relevant structural or functional cardiovascular abnormality

O

Outcome

Associations between myocardial mechanics (LV-GLS, LV torsion) and haemodynamic variables (backward-flow burden) assessed using correlation analyses and multivariable linear regressionsurrogate

Main Result

Absolute Event Rate: -19.7% vs -21.2%

p-value: p=<0.001

In young adults with bicuspid aortic valve, increased backward aortic flow is independently associated with subclinical impairment of left ventricular longitudinal strain despite preserved ejection fraction.

Limitations

Single-centre design
Modest sample size
Young and selected population
Heterogeneous valve and aortic phenotypes
Cross-sectional assessment prevents determination of temporal or causal relationships
Two-dimensional phase-contrast CMR cannot characterize full three-dimensional flow
Potential residual confounding
modest cohort size
limited number of covariates that could be included simultaneously
potential residual confounding by hypertension, transaortic haemodynamics, valve morphology, aortic stiffness, and other measures of aortic geometry
cross-sectional study design precludes establishing temporal and causal relationships

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Implication

Subclinical LV-GLS impairment in young BAV patients may warrant closer surveillance; leaves open whether backward flow drives progression.

Abstract

Objectives: The presence of a bicuspid aortic valve (BAV) is known to alter transvalvular flow and increase shear stress on the ascending aorta, contributing to alterations in aortic geometry and the progression of BAV-related aortopathy. The purpose of the current study was to characterize aortic flow abnormalities and their associations with aortic geometry and ventricular mechanics using cardiac magnetic resonance imaging (CMR). Methods: In this prospective cross-sectional study, 56 young adults with CMR-confirmed BAV and 56 age- and sex-matched healthy volunteers underwent standardized CMR. Biventricular volumes and function, LV global longitudinal strain (LV-GLS), LV torsional mechanics, ascending aortic geometry, pulse-wave velocity, aortic distensibility, and two-dimensional phase-contrast-derived forward and backward flow parameters were quantified. Associations between myocardial mechanics and haemodynamic variables were assessed using correlation analyses and multivariable linear regression. Results: Compared with healthy controls, patients with BAV exhibited preserved LV ejection fraction but impaired LV-GLS, reduced LV torsion, increased aortic stiffness, and a significantly greater backward-flow burden despite similar net aortic flow (all p < 0.001). Higher peak backward-to-forward flow-rate ratios were associated with less negative LV-GLS (p = 0.006), whereas greater aortic regurgitant volume was also associated with impaired longitudinal deformation (p = 0.001). In multivariable analysis, LV-GLS and aortic regurgitant volume remained associated with the peak backward-to-forward flow-rate ratio within the specified model, whereas ascending-aortic dimensions were not. The final model explained 52% of the variability in backward-flow burden. Conclusions: CMR identified a subclinical ventricular-aortic phenotype in young adults with BAV characterized by altered LV mechanics, increased aortic stiffness, and greater relative backward-flow burden despite preserved conventional LV systolic function. The association between backward-flow burden and LV longitudinal mechanics suggests that these abnormalities may represent interrelated manifestations of BAV disease; however, their temporal and causal relationships cannot be established from this cross-sectional study.

Discussion

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Cite This Study

Man et al. (2026) conducted a cross-sectional in Bicuspid aortic valve (n=112). Bicuspid aortic valve vs. Healthy volunteers was evaluated on Left ventricular global longitudinal strain (LV-GLS) (p=<0.001). Young adults with bicuspid aortic valve exhibited impaired left ventricular global longitudinal strain (-19.7% vs -21.2%) and a significantly greater backward-flow burden compared to healthy controls.

synapsesocial.com/papers/6a9b80e1794a4a4077c7e7ab https://doi.org/10.3390/jcm15176828

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Backward Aortic Flow Is Associated with Impaired Left Ventricular Mechanics in Young Adults with Bicuspid Aortic Valve: A Prospective Cardiovascular Magnetic Resonance Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Backward Aortic Flow Is Associated with Impaired Left Ventricular Mechanics in Young Adults with Bicuspid Aortic Valve: A Prospective Cardiovascular Magnetic Resonance Study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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