Real-time three-dimensional echocardiographic assessment of the association between aortic diameter and left ventricular mechanical dyssynchrony in patients with bicuspid aortic valve

Q: What are the key findings of this study?

In patients with bicuspid aortic valve, aortic dilation was independently associated with greater left ventricular mechanical dyssynchrony (Tmsv16-SD%) despite preserved ejection fraction.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Bicuspid aortic valve (n=119). Intervention: Aortic dilation (sinus of Valsalva size index or ascending aortic size index >2.1 cm/m²) vs. Bicuspid aortic valve without aortic dilation and healthy controls. Primary outcome: Standard deviation in the time to minimum systolic volume across 16 LV segments (Tmsv16-SD%) (β=4.447 for SOVSI, β=3.388 for AASI, p=<0.001).

Q: What does this research mean for the field?

In patients with bicuspid aortic valve, aortic dilation is independently associated with greater left ventricular mechanical dyssynchrony despite preserved ejection fraction. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

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

To evaluate the relationship between body surface area-indexed aortic diameter and left ventricular mechanical dyssynchrony using real-time three-dimensional echocardiography in patients with bicuspid aortic valve.

Huan Liu; Xueting Guo; Kunxuan Liu; Qinlin Li; Caiyun Zhang; Kuican Liu; wenrong Shi; Wenjuan Qin; Lei Huang

doi:10.21037/qims-2026-0762

September 23, 2026Quantitative Imaging in Medicine and SurgeryOpen Access

Real-time three-dimensional echocardiographic assessment of the association between aortic diameter and left ventricular mechanical dyssynchrony in patients with bicuspid aortic valve

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Key result

Aortic dilation in BAV is linked to greater LV mechanical dyssynchrony despite preserved EF.

β=4.447 for SOVSI, β=3.388 for AASI
P<0.001
n=119

Figures

Why the study?

The relationship between aortic diameter and left ventricular mechanical dyssynchrony in patients with bicuspid aortic valve was limited and needed investigation.

Is aortic dilation associated with increased left ventricular mechanical dyssynchrony in patients with bicuspid aortic valve?

Key Points

To evaluate the relationship between body surface area-indexed aortic diameter and left ventricular mechanical dyssynchrony using real-time three-dimensional echocardiography in patients with bicuspid aortic valve.
Retrospectively analyzed 79 patients with bicuspid aortic valve and 40 normal controls.
Measured sinus of Valsalva and ascending aortic diameters via coronary computed tomography angiography to calculate body surface area-indexed size indices (SOVSI and AASI), categorizing patients into non-dilated (≤2.1 cm/m²) and dilated (>2.1 cm/m²) groups.
Used real-time three-dimensional echocardiography to quantify the standard deviation and maximal difference in time to minimum systolic volume across 16, 12, and 6 left ventricular segments (Tmsv16/12/6-SD% and Tmsv16/12/6-Dif%).
Patients with bicuspid aortic valve exhibited increased systolic dyssynchrony indices compared with controls, with significantly higher values in the dilated group than the non-dilated group (P<0.001) despite similar left ventricular ejection fractions.
Patients with dilation of the sinus of Valsalva or ascending aorta had lower E/A ratios and higher E/e' ratios compared with controls.
Multiple linear regression identified SOVSI (β=4.447, P<0.001), AASI (β=3.388, P<0.001), and E/e' (β=0.727, P<0.001) as independent factors associated with Tmsv16-SD%.

Study Design

Type

Observational (n=119)

Multicenter

No

Structured PICO

Is aortic dilation associated with increased left ventricular mechanical dyssynchrony in patients with bicuspid aortic valve?

P

Population

119 participants, including 79 patients with bicuspid aortic valve and normal left ventricular ejection fraction, and 40 healthy controls, evaluated retrospectively to assess the association between aortic dilation and left ventricular mechanical dyssynchrony.

E

Exposure

Aortic dilation, defined as body surface area-indexed sinus of Valsalva size index (SOVSI) or ascending aortic size index (AASI) >2.1 cm/m².

C

Comparator

Patients with bicuspid aortic valve without aortic dilation (SOVSI and AASI ≤2.1 cm/m²) and healthy controls.

O

Outcome

Standard deviation in the time to minimum systolic volume across 16 left ventricular segments (Tmsv16-SD%) assessed by real-time three-dimensional echocardiography.surrogate

Main Result

Effect estimate: β=4.447 for SOVSI, β=3.388 for AASI

p-value: p=<0.001

Aortic dilation in bicuspid aortic valve is linked to significant subclinical left ventricular mechanical dyssynchrony, suggesting early electromechanical myocardial impairment prior to a drop in ejection fraction.

Limitations

Single-center study with a relatively small sample size
Exclusion of 12 participants (12.5%) due to suboptimal image quality may have introduced selection bias
Lack of long-term follow-up limits assessment of longitudinal progression
Single-center study with small sample size
Exclusion of 12.5% of patients due to suboptimal image quality (selection bias)
No long-term follow-up to evaluate temporal changes

Implication

Aortic dilation may flag subclinical LV dyssynchrony in bicuspid aortic valve despite preserved EF; leaves open whether this alters surveillance or predicts outcomes.

Abstract

Background: Bicuspid aortic valve (BAV) is frequently accompanied by aortic dilation (AD), which may impair left ventricular (LV) function. However, research on the relationship between aortic diameter and left ventricular mechanical dyssynchrony (LVMD) is limited. This study aimed to investigate the association between the body surface area (BSA)-indexed aortic size index (ASI) and the three-dimensional systolic dyssynchrony index (3D-SDI) as assessed by real-time three-dimensional echocardiography (RT-3DE) in patients with BAV. Methods: This study retrospectively included 79 patients with BAV and 40 normal individuals. Coronary computed tomography angiography (CCTA) was used to measure the internal diameters of the sinus of Valsalva and the ascending aorta in patients with BAV. These measurements were indexed to BSA to calculate the sinus of Valsalva size index (SOVSI) and the ascending aortic size index (AASI), respectively. Patients with BAV were divided into two groups based on the SOVSI and AASI, respectively: the non-dilated group (≤2.1 cm/m²) and the dilated group (>2.1 cm/m²). RT-3DE was used to measure the standard deviation (SD) and maximal difference in the time to minimum systolic volume (Tmsv) across 16, 12, and 6 LV segments. These parameters were expressed as percentages of the cardiac cycle (Tmsv16/12/6-SD% and Tmsv16/12/6-Dif%, respectively). Spearman correlation analysis was conducted to assess the associations between the study variables and Tmsv16-SD%. Multiple linear regression analysis was then performed to identify the factors independently associated with Tmsv16-SD%. Results: Compared with the controls, patients with BAV exhibited LVMD, as indicated by increased Tmsv16-SD%, Tmsv12-SD%, Tmsv6-SD%, Tmsv16-Dif%, Tmsv12-Dif%, and Tmsv6-Dif%. This increase was more pronounced in the dilated group than in the non-dilated group (P<0.001); however, no significant difference in left ventricular ejection fraction (LVEF) was observed between these two subgroups. Among patients with BAV, those with dilation of the sinus of Valsalva or the ascending aorta also had lower E/A (E, peak early diastolic mitral inflow velocity; A, peak late diastolic mitral inflow velocity) ratios and higher E/e' (e', peak early diastolic mitral annular velocity) ratios. In a multiple linear regression analysis, Tmsv16-SD% was independently associated with SOVSI (β=4.447, P<0.001), AASI (β=3.388, P<0.001), and E/e' (β=0.727, P<0.001). Conclusions: Patients with BAV exhibit LVMD, which is more pronounced in those with concomitant AD. Both SOVSI and AASI are independently associated with LVMD. The study findings provide further evidence of an association between AD and greater LVMD in patients with BAV.

Discussion

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Cite This Study

Liu et al. (2026) conducted an observational in Bicuspid aortic valve (n=119). Aortic dilation (sinus of Valsalva size index or ascending aortic size index >2.1 cm/m²) vs. Bicuspid aortic valve without aortic dilation and healthy controls was evaluated on Standard deviation in the time to minimum systolic volume across 16 LV segments (Tmsv16-SD%) (β=4.447 for SOVSI, β=3.388 for AASI, p=<0.001). In patients with bicuspid aortic valve, aortic dilation was independently associated with greater left ventricular mechanical dyssynchrony (Tmsv16-SD%) despite preserved ejection fraction.

synapsesocial.com/papers/6ad0fd553afa093ea9ad03f2 https://doi.org/10.21037/qims-2026-0762

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Real-time three-dimensional echocardiographic assessment of the association between aortic diameter and left ventricular mechanical dyssynchrony in patients with bicuspid aortic valve

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Real-time three-dimensional echocardiographic assessment of the association between aortic diameter and left ventricular mechanical dyssynchrony in patients with bicuspid aortic valve

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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