The Echocardiography Study Of Artery Elasticity And Left Ventricular Function In Association With Normally Functioning Bicuspid Aortic Valve

Objective:Bicuspid aortic valve?BAV?is the common congenital heart disease.This condition is associated with aortophthy including aortic dilation or aneurysm despite of absence of significant valve dysfunction.Excised from the proximal aortas of patients with BAV,intima-media structural of aortic wall is abnormal and MMPs is expressed in abundance.This change may affect other arteries.Aortic stiffness consequently may affect left ventricular systolic and diastolic function adversely.The study aimed to evaluate aortic elasticity?carotid elasticity and left ventricular function between BAV morphologic findings?raphe vs nonraphe?by pulse wave velocity?PWV??speckle tracking imaging and tissue Doppler imaging.Methods:34 patients?BAV group?with diagnosis of BAV were enrolled in this study.According to Sievers'classify,BAV group was divided into two subgroups,type 0group?nonraphe?and type 1 group?one raphe?.20 age and sex matched adults were included as control group.The parameters of aortic elasticity?carotid elasticity and left ventricular systolic?diastolic function were detected and analyzed.1?Aortic elasticity parameters:aortic diastolic dimension?AoD?,aortic systolic dimension?AoS?,aortic strain,aortic stiffness index?AoSI?,aortic distensibility?AoDIS?.2?Carotid elasticity parameters:intimate-media thickness?IMT?,pulse wave velocity-beginning of the systole?PWV-BS?,pulse wave velocity-end of the systole?PWV-ES?.3?Conventional echocardiography parameters:interventricular septum thickness?IVST?,posterior wall thickness?LVPWT?,relative wall thickness?RWT?,left ventricular mass?LVMass?,left ventricular mass index?LVMI?,aortic valve velocity?AVV?,aortic valve area?AVA?,peak gradient?PG?,mean gradient?MG?.4?Left ventricular systolic parameters:systolic global peak longitudinal strain?GLS?,systolic global peak radial strain?GRS?,systolic global peak circumferential strain?GCS?,left ventricular ejection fraction?LVEF?.5?Left ventricular systolic function parameters:peak early diastolic flow velocity?E?,peak late diastolic flow velocity?A?,early diastolic mitral annular velocity of ventricular septum(e'_septal),early diastolic mitral annular velocity of ventricular lateral wall(e'_lateral),left atrial volume?LAV?,left atrial volume index?LAVI?.Results:1?Aortic elasticity:?Type 0 compared with controls:The AoD and AoS of type 0 were significant larger?P<0.01?,aortic strain was significant lower?P<0.01?and AoDIS was lower than those in controls?P<0.05?.?Type 1 compared with controls:The AoD and AoS of type 1 were significant larger?P<0.01?,Aortic strain and AoDIS was significant lower?P<0.01?,and AoSI was lower?P<0.05?.?Type 1 compared with type 0:Aortic strain was lower than that in type 0?P<0.05?,and AoSI was significant higher?P<0.01?.2?Carotid elasticity:?BAV group compared with controls:PWV-BS and PWV-ES of left carotid and PWV-ES of right carotid in BAV group were significant higher than those in controls?P<0.01?,PWV-BS and PWV-ES of left carotid were higher than those of right?P<0.05?.?Type 0 compared with controls:PWV-BS and PWV-ES of left carotid in type 0BAV were higher than those in controls?P<0.05?,PWV-ES of right carotid was significant higher than that in controls?P<0.01?.?Type 1 compared with controls:PWV-BS and PWV-ES of left carotid in type 1were significant higher than those in controls?P<0.01?,PWV-ES of right carotid was higher than that in controls?P<0.05?.?Type 1 compared with type 0:No significant difference between PWV-BS and PWV-ES of type 0 and type 1.3?The parameters of conventional echocardiography:?Type 0 compared with controls:IVST in type 0 was higher than controls?P<0.05?,and RWT was significant higher than controls?P<0.01?.?Type 1 compared with controls:IVST?RWT and LVMI in type 1 were significant higher than controls?P<0.01?.?Type 1 compared with type 0:IVST and RWT were higher than type 0?P<0.05?.4?Left ventricular systolic function:GLS of type 0 and 1 was lower than that in controls?P<0.01?.5?Left ventricular diastolic function:?Type 0 compared with controls:e'_septaleptal of type 0 was lower than that in controls?P<0.05?.?Type 1 compared with controls:e'_septal and e'_lateralateral of type1 was lower than that in controls?P<0.01?,LAD and LAVI were larger than controls?P<0.05?.?Type 1 compared with type 0:e'_septal of type 1 was lower?P<0.05?,LAD and LAVI were larger than type 0?P<0.05?.?E'_lateral and e'_septaleptal have positive correlation with aortic strain and AoDIS,and have negative correlation with AoSI.Conclusions:1?Aortic elasticity reduced in patients with BAV,further reduced in Type 1.2?Carotid elasticity reduced in patients with BAV,and left carotid was associated with more advanced damage of carotid elasticity than right.There was no significant change in carotid elasticity in different types of BAV.3?When LVEF is normal,the BAV patients of type 0 and type 1 had left ventricular systolic dysfunction in varying degree and further damaged in type 1.4?The parameters of left ventricular systolic function of the BAV patients were reduced compared to control subjects.E'_lateral and e'_septal were related to the parameters of artery elasticity.