In selected patients with BAV who maintained preserved LVEF without valve or aortic surgery, LV GLS and LA reservoir strain decreased slightly over 1 year, though clinical significance requires validation with longitudinal controls and test-retest data.
At baseline, adults with bicuspid aortic valve and preserved EF had lower absolute LV global longitudinal strain than age- and sex-matched tricuspid aortic valve controls.
At baseline, BAV patients also had lower left atrial reservoir strain (LASr) than controls.
Over about 1 year, mean LVEF and LV volumes did not change significantly in BAV patients, while absolute GLS decreased slightly.
LA reservoir strain decreased over 1 year in BAV patients.
Gradient-corrected global work index decreased over 1 year (exploratory outcome).
A minority of patients showed a GLS decrease exceeding the intra-observer minimal detectable change.
The change in GLS was not significantly associated with valve lesion type or severity.
The authors conclude the strain decreases were slight and that their clinical significance needs validation.
This study looked at adults born with a bicuspid aortic valve (a valve with two flaps instead of three) whose hearts still pumped normally by the usual measure, ejection fraction. Researchers compared heart ultrasound scans taken about one year apart in 82 such patients, and compared their first scans with those of 40 people with normal three-flap valves. Even though the pumping measure looked normal, the patients' heart muscle shortening (strain) and the filling function of the upper-left heart chamber were already lower than in the comparison group. Over one year, the usual pumping measure and heart chamber sizes did not change, but the strain measurements of both the main pumping chamber and the left atrium dropped slightly. The drop in heart-muscle strain was about 0.8 percentage points, and a measure of heart work efficiency also fell. About one in four patients had a decline larger than the measurement error of the method. The change did not clearly depend on the type or severity of the valve problem. This research suggests that strain measures might pick up subtle heart changes before the standard pumping measure changes. However, the changes were small, the study was retrospective and included only selected patients who did not need surgery, and the control group was scanned only once, so it is unclear what the drops mean for patients' health. The authors say more research with repeated scans in controls and repeat-measurement data is needed.
Yalman H, Aygün A, Temiz M, Raimoglou D, Çimci M. (2026). Bicuspid Aortic Valve With Preserved Ejection Fraction: One-Year Changes in Ventricular and Atrial Mechanics.. Echocardiography (Mount Kisco, N.Y.). https://doi.org/10.1111/echo.70665