Evaluation of left ventricular myocardial mechanics in patients with normally functioning bicuspid aortic valves: A systematic review and meta‐analysis

Abstract

BackgroundStudies have found conflicting results concerning the left ventricular (LV) myocardial deformation properties in patients with normally functioning bicuspid aortic valves (BAVs). Whether the remodeling process of LV occurs independently in patients with BAV is a matter of debate.MethodWe searched PubMed, Embase, Cochrane library, and Web of Science for cohort studies aiming to assess LV function in adults with isolated BAV compared with tricuspid aortic valve (TAV) controls. Standard mean difference (SMD) was calculated from random‐effects meta‐analyses.ResultsEight cohort studies were included. There were significantly lower global longitudinal strain (GLS), global radial strain (GRS), global circumferential strain (GCS) in BAV than in TAV controls (GLS: SMD = 0.64, 95% CI: 0.35 to 0.92, P < .0001; GRS: SMD = −0.71, 95% CI: −1.09 to −0.32, P = .0003; GCS: SMD = 0.70, 95% CI: 0.41 to 0.98, P < .00001) and significantly higher left atrial volume index (LAVI) and E/e’ in BAV than in TAV controls (LAVI: SMD = 0.50, 95% Cl: 0.12 to 0.88, P = .01; E/e’: SMD = 0.54, 95% CI: 0.30 to 0.77, P < .00001). There was significantly higher Left ventricular mass index（LVMI） in BAV than in TAV controls (SMD = 0.51, 95% CI: 0.24 to 0.79, P = .0003). Left ventricular ejection fraction (LVEF) was not significantly different between BAV patients and TAV controls (SMD = 0.05, 95% CI: −0.16 to 0.26, P = .63).ConclusionThe impairment of LV myocardial mechanics, including LV systolic, diastolic dysfunction and LV hypertrophy, is present in patients with normally functioning BAV. This might support the hypothesis that BAV is not only a valvular disease but also a myocardial disease.

Patients With Bicuspid Aortic Stenosis Demonstrate Adverse Left Ventricular Remodeling and Impaired Cardiac Function Before Surgery With Increased Risk of Postoperative Heart Failure

“…11,[32][33][34] In line with the findings of the present study, several others have found a higher LV mass and subclinical LV dysfunction in young patients with BAV, suggesting that the compensatory concentric remodeling process begins early in life. 10,35 A future large longitudinal study that follows patients with BAV from an early age and forward might give us information about when adverse LV remodeling is initiated and how it is affected by aortic valve degeneration. Furthermore, analyzing LV structure and function in different age groups of patients with BAV referred for AVR could also potentially support the concept of an age-dependent adverse LV remodeling.…”

“…Data from several cross-sectional studies suggest that adolescents and young adults with a BAV show early signs of adverse structural LV remodeling even in the absence of valvular dysfunction. 10 Consequently, impaired LV function is more common in individuals with BAV compared with age- and sex-matched TAV controls, and is probably related to a chronically elevated afterload attributable to eccentric aortic valve opening and decreased ascending aortic elasticity. 11 , 12 In longitudinal studies, it has been shown that individuals with BAV exhibit a higher risk of premature congestive heart failure (HF) than the general population.…”

Noninvasive left ventricular pressure-strain myocardial work in patients with well-functioning bicuspid aortic valves and aortic dilation: a preliminary study

“…Interestingly, in patients with BAV and no ascending aortic dilatation, GWW increased and GWE decreased as compared with controls, although the aortic diameter and aortic stiffness index were similar. These findings offer a novel perspective of BAV as being not only a valvulo-aortopathy disease but also a form of cardiomyopathy ( 35 , 36 ).…”