Key result
Bicuspid aortic valve linked to ~0.8-point 1-year decline in LV global longitudinal strain despite preserved LVEF.
Why the study?
Left ventricular dysfunction in bicuspid aortic valve disease may precede a decline in ejection fraction, motivating assessment of 1-year changes in left ventricular global longitudinal strain, left atrial strain, and myocardial work in patients with preserved ejection fraction.
Cohort (n=122)
In adults with bicuspid aortic valve and preserved ejection fraction who do not undergo surgery, left ventricular global longitudinal strain and left atrial reservoir strain show slight subclinical declines over 1 year despite stable LVEF.
Answers are grounded in this paper and cite their sources.
May support GLS for detecting subtle LV changes despite stable LVEF; leaves open prospective validation before clinical adoption.
PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
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Yalman et al. (2026) conducted a cohort in Bicuspid aortic valve with preserved ejection fraction (n=122). Bicuspid aortic valve with preserved LVEF vs. Baseline measurements (for 1-year longitudinal change) and age- and sex-matched controls with tricuspid aortic valves (at baseline) was evaluated on 1-year changes in absolute left ventricular global longitudinal strain (GLS) and left atrial reservoir strain (LASr) (MD -0.8% points (GLS); MD -2.4% points (LASr), 95% CI 0.5-1.1, p=< 0.001 (Holm-adjusted)). Bicuspid aortic valve with preserved LVEF was associated with 1-year decreases in absolute LV GLS by 0.8% points (95% CI 0.5-1.1) and LA reservoir strain by 2.4 points (95% CI 1.7-3.0; both p<0.001).
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