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Aortic strain in bicuspid aortic valve: an analysis

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Abstract

Bicuspid aortic valve (BAV) is monitored by transthoracic echocardiography and computed tomography (CT) angiography. However, it does not have any early marker of disease progression. This study evaluated speckle-tracking echocardiography (STE) aortic and left ventricular (LV) strain prognostic values, their discriminative power, and their correlation with the degree of valvular regurgitation. We conducted a retrospective analysis of a prospectively enrolled cohort of 45 diagnosed with BAV and 20 gender and age matched controls. We performed 2D-STE aortic and LV strain analysis of the selected population. The cohort was followed-up during a median period of 19.9 months (IQR 12.9–25.2), and outcomes (hospital admission for heart failure (HF), aortic valve replacement (AVR), and death) were determined. The mean patient age was 46.6 ± 15.5 years and 80 % were male. LV indexed volumes and aortic diameter were higher in BAV patients. LV global longitudinal strain (GLS) was impaired (p < 0.001) and aortic GLS was significantly augmented (p = 0.027) in BAV patients. Aortic global circumferential strain (GCS) did not vary between groups. Aortic diameter was the best parameter related to BAV (AUC 0.92) and aortic GLS was best correlated with significant AR (AUC 0.76). AVR was the only outcome observed and its only predictor was indexed LV end-diastolic volume. BAV had impaired LV-GLS values. Aortic GLS was abnormally augmented in BAV patients, which might reflect higher aortic diameters that distorted strain calculations. STE aortic strain is related to AR but does not appear to be a reliable predictor of surgery in BAV patients, at 19 months.

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Abbreviations

2D:

Two-dimensional

Ao-CSmax:

Aortic circumferential strain (maximum)

Ao-CSmin:

Aortic circumferential strain (minimum)

Ao-GCS:

Aortic global circumferential strain

Ao-GLS:

Aortic global longitudinal strain

Ao-LSmax:

Aortic longitudinal strain (maximum)

Ao-LSmin:

Aortic longitudinal strain (minimum)

AR:

Aortic regurgitation

AS:

Aortic stenosis

AUC:

Area under the curve

AVR:

Aortic valve replacement

BAV:

Bicuspid aortic valve

CI:

Confidence interval

CT:

Computed tomography

GLS:

Global longitudinal strain

HF:

Heart failure

IQR:

Interquartile range

IVS:

Interventricular septum

LV:

Left ventricle

LVEDD:

Left ventricle end-diastolic diameter

LVEDVi:

Left ventricle end-diastolic volume (indexed)

LVEF:

Left ventricle ejection fraction

LV-GLS:

Left ventricle global longitudinal strain

ROC:

Receiver operating characteristics

STE:

Speckle-tracking echocardiography

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    Authors and Affiliations

    1. Faculty of Medicine, Universidade de Coimbra, Coimbra, Portugal

      Tomás Carlos, André Azul Freitas, Patrícia Marques Alves, Rui Martins & Lino Gonçalves

    2. Department of Cardiology, Centro Hospitalar e Universitário de Coimbra, Praceta Mota Pinto, Coimbra, 3000-001, Portugal

      André Azul Freitas, Patrícia Marques Alves, Rui Martins & Lino Gonçalves

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    1. Tomás Carlos and André Azul Freitas have contributed equally to this work.

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      Correspondence to Patrícia Marques Alves.

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      Carlos, T., Freitas, A.A., Alves, P.M. et al. Aortic strain in bicuspid aortic valve: an analysis. Int J Cardiovasc Imaging 37, 2399–2408 (2021). https://doi.org/10.1007/s10554-021-02215-1

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