Left ventricular strain in pediatric patients with bicuspid aortic valves and aortopathy

Background

Bicuspid aortic valve is the most common congenital cardiac defect. Left ventricular strain has been shown to be lower in adults with bicuspid aortic valve and preserved ejection fraction. Additionally, left ventricular strain has been independently associated with aortic valve replacement and all-cause mortality in adults. In pediatric patients, left ventricular strain in patients with bicuspid aortic valve with and without aortopathy has not been evaluated.

Objectives

We aimed to evaluate the effect of clinical aortopathy on left ventricular strain in pediatric patients with well-functioning bicuspid aortic valve compared to normal controls.

Methods

This is a single-center retrospective study in patients <21 years of age with normal ejection fraction and no prior cardiac interventions. Patients were divided into three groups: 1) healthy controls with normal transthoracic echocardiograms 2) well-functioning BAV without clinical aortopathy 3) well-functioning BAV with isolated clinical aortopathy. TTE images were analyzed to obtain left ventricle global longitudinal strain and left ventricle global circumferential strain, respectively. Strain values were compared across the three groups.

Results

The mean values and 95 % confidence intervals (95%CIs) for LVGLS were −23.1 (−24.3, −22.0), −22.5 (−23.8, −21.1), and −21.2 (−22.5, −20.0) for groups 1, 2 and 3 respectively. There was a statistically significant difference in Left ventricular global longitudinal strain in group 3 compared to group 1(p = 0.033). There was no significant difference in global circumferential strain between the three groups.

Conclusion

Our study demonstrates lower left ventricular strain in patients with a well-functioning bicuspid aortic valve and clinical aortopathy compared to controls. This is suggestive of an early effect on the left ventricular myocardium caused by a change in loading conditions from alteration in aortic elasticity. Left ventricular strain is a potential early marker for this and can be utilized for further correlation with clinical outcomes.