Prognostic implications of left ventricular global longitudinal strain in patients with bicuspid aortic valve disease and preserved left ventricular ejection fraction

Abstract

Aims In patients with bicuspid aortic valve (BAV) and preserved left ventricular (LV) ejection fraction (EF), the frequency of impaired LV global longitudinal strain (GLS) and its prognostic implications are unknown. The present study evaluated the proportion and prognostic value of impaired LV GLS in patients with BAV and preserved LVEF. Methods and results Five hundred and thirteen patients (68% men; mean age 44 ± 18 years) with BAV and preserved LVEF (>50%) were divided into five groups according to the type of BAV dysfunction: (i) normal function BAV, (ii) mild aortic stenosis (AS) or aortic regurgitation (AR), (iii) ≥moderate isolated AS, (iv) ≥moderate isolated AR, and (v) ≥moderate mixed AS and AR. LV systolic dysfunction based on 2D speckle-tracking echocardiography was defined as a cut-off value of LVGLS (−13.6%). The primary outcome was aortic valve intervention or all-cause mortality. The proportion of patients with LVGLS ≤−13.6% was the highest in the normal BAV group (97%) and the lowest in the group with moderate and severe mixed AS and AR (79%). During a median follow-up of 10 years, 210 (41%) patients underwent aortic valve replacement and 17 (3%) died. Patients with preserved LV systolic function (LVGLS ≤ −13.6%) had significantly better event-free survival compared to those with impaired LV systolic function (LVGLS > −13.6%). LVGLS was independently associated with increased risk of events (mainly aortic valve replacement): hazard ratio 1.09; P < 0.001. Conclusion Impaired LVGLS in BAV with preserved LVEF is not infrequent and was independently associated with increased risk of events (mainly aortic valve replacement events).

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

“…Results of the meta-analysis comparing BAV patients and TAV controls Abbreviations: BAV = bicuspid aortic valve; CMRFT = cardiac magnetic resonance feature tracking; GCS = global circumferential strain; GLS = global longitudinal strain; GRS = global radial strain; LVEF = left ventricular ejection fraction; TAV = tricuspid aortic valve. and circumferential functions to increased afterload; longitudinal function is impaired early, suggesting that GLS is the most sensitive and consistent parameter,39,40 impaired LVGLS in BAV with preserved LVEF is frequent and was independently associated with increased risk of aortic valve replacement events 41. Early reduction of LV strain in our study is a sign of subclinical myocardial changes, and it appears to forecast the development of subsequent cardiotoxicity in BAV, as seen in the review.…”

Review: application of current imaging modalities in the management of left-sided valvular heart disease

“…DMF is thought to be reversible, while FMF is thought to be irreversible, with the latter associated with significantly poor postoperative outcomes (19)(20)(21)(22). In a similar manner, regional and global longitudinal strain (GLS) are also reported to have a greater and earlier diagnostic power than left ventricular ejection fraction (LVEF) (23,24). There are also reports of using left atrial (LA) global strain and LA dilation for prediction of AS prognosis, however, whether this is a suitable sign for early intervention remains to be validated (25,26).…”

The year in cardiovascular medicine 2020: imaging

“…Kong i sur. 5 proveli su istraživanje u kojemu su ispitivali udio i prognostičku vrijednost poremećaja globalnoga longitudinalnog straina (GLS) LV-a u bolesnika s BAV-om i očuvanom ejekcijskom frakcijom LV-a (LVEF). Ispitivani su udio i prognostička vrijednost poremećaja LV-GLS-a u bolesnika s BAV-om i očuvanom LVEF.…”

“…That is the case of patients with bicuspid aortic valve (BAV). Kong et al, 5 realized a study to evaluate the proportion and prognostic value of impaired LV global longitudinal strain (GLS) in patients with BAV and preserved LV ejection fraction (EF). It evaluated the proportion and prognostic value of impaired LV GLS in patients with BAV and preserved LVEF.…”