Evaluation Of Myocardial Strain And Artery Elasticity Using Speckle Tracking Echocardiography And High-resolution Ultrasound In Patients With Bicuspid Aortic Valve

PART I Evaluation of Artery Elasticity Using High-resolution Ultrasound in Patients with Bicuspid Aortic ValveObjective:The study sought to evaluate aortic and carotid elasticity in bicuspid aortic valve (BAV) patients with dilation of proximal ascending aorta in comparison with BAV patients without dilation of proximal aorta and healthy control subjects using high-resolution ultrasound.Methods:We studied fifty-seven BAV patients categorized into 2 subgroups according to proximal ascending aortic dimensions (nondilated< 35 mm and dilated>35mm). Twenty-nine healthy subjects with trileaflet aortic valve were recruited as control. Standard echocardiography and M-Mode echocardiography were performed in all subjects. Aortic and carotid end-diastolic diameters and end-systolic diameters were measured by M-mode echocardiography. Aortic and carotid strain, distensibility and stiffness index were derived.Results:BAV patients with dilation of proximal ascending aorta had not only larger aortic size but also larger carotid diameter when compared with BAV patients without dilation of proximal ascending aorta and the controls. In contrast, aortic and carotid diameter did not differ between BAV patients without dilation of proximal ascending aorta and the controls. In BAV patients with or without dilation of proximal ascending aorta, aortic strain and distensibility was lower and aortic stiffness index was higher than those in controls. Furthermore, BAV patients with dilation of aorta had lower aortic strain, lower distensibility and higher stiffness index in comparison with BAV patients without dilation of aorta. Similarly, carotid strain and distensibility was lower and carotid stiffness index was higher in BAV patients with or without dilation of aorta than those in controls, while BAV patients with dilation of aorta had lower carotid strain, lower distensibility and higher stiffness index in comparison with BAV patients without dilation of aortaConclusion:Our study reveals widespread alterations of artery elasticity in BAV patients. Although BAV patients manifest reduced aortic and carotid elasticity regardless of the proximal ascending aortic dimension, dilation of proximal ascending aorta is associated with more advanced damage of aortic and carotid elasticity in BAV patients, supporting the need for detailed and extensive vascular surveillance in BAV patients.PART II Evaluation of Myocardial Strain Using Speckle Tracking Echocardiography in Patients with Bicuspid Aortic ValveObjective:The study sought to evaluate myocardial mechanics in bicuspid aortic valve (BAV) patients with dilation of proximal ascending aorta in comparison with BAV patients without dilation of proximal aorta and healthy control subjects using speckle tracking echocardiography.Methods:We studied fifty-seven BAV patients categorized into 2 subgroups according to proximal ascending aortic dimensions (nondilated< 35 mm and dilated?35mm). Twenty-nine healthy subjects with trileaflet aortic valve were recruited as control. Standard echocardiography and speckle-tracking echocardiography were performed in all subjects. Left ventricular myocardial strains were acquired with speckle-tracking echocardiography.Results:Lower longitudinal, circumferential and radial myocardial strains were demonstrated in both BAV patients with dilation of proximal ascending aorta and those without dilation of proximal ascending aorta in comparison with the controls. Furthermore, BAV patients with dilation of proximal ascending aorta had lower longitudinal, circumferential and radial myocardial strain compared with BAV patients without dilation of proximal ascending aorta.Conclusion:Our study reveals a widespread alteration of myocardial mechanics in BAV patients. Although BAV patients manifest reduced myocardial strain regardless of the proximal ascending aortic dimension, dilation of proximal ascending aorta is associated with more advanced damage of myocardial strain in BAV patients, supporting the need for detailed and extensive cardiac surveillance in BAV patients.