Deng Wenhui, Tan Yuting, Shi Jiawei, He Shukun, Liu Tianshu, Wu Wenqian, Li Yuman, Yang Yali, Zhang Li, Xie Mingxing, Wang Jing
Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Clinical Research Center for Medical Imaging in Hubei Province, Wuhan, China.
Front Cardiovasc Med. 2024 Aug 8;11:1405754. doi: 10.3389/fcvm.2024.1405754. eCollection 2024.
The impact of aortic stenosis (AS) severity on multidirectional myocardial function in patients with bicuspid aortic valve (BAV) remains unclear, despite the recognized presence of early left ventricular longitudinal myocardial dysfunction in BAV patients with normal valve function. The aim of the study was to evaluate the multidirectional myocardial functions of BAV patients.
A total of 86 BAV patients (age 46.71 ± 13.62 years, 69.4% men) with normally functioning (BAV-nf), mild AS, moderate AS, and severe AS with preserved left ventricular ejection fraction (LVEF ≥ 52%) were included. 30 healthy volunteers were recruited as the control group. Multidirectional strain and volume analysis were performed by three-dimensional speckle tracking echocardiography(3D-STE).
Global longitudinal strain (GLS), and global radial strain (GRS) were reduced in BAV-nf patients compared with the controls. With each categorical of AS severity from BAV-nf to severe AS, there was an associated progressive impairment of GLS and GRS (all < 0.001). Global circumferential strain (GCS) did not show a significant decrease from BAV-nf to mild AS but began to decrease from moderate AS. Multiple linear regressions indicated that indexed aortic valve area (AVA/BSA), as a measure of AS severity, was an independent determinant of GLS, GCS and GRS.
Left ventricular longitudinal myocardial reduction is observed even in patients with well-functioning bicuspid aortic valves. With each categorical increase in the grade of AS severity from normally functioning to severe aortic stenosis, there was an associated progressive impairment of longitudinal myocardial function. Furthermore, circumferential myocardial function was starting damaged from moderate AS. AVA/BSA was independently associated with multidirectional myocardial function injuries.
尽管已认识到瓣膜功能正常的二叶式主动脉瓣（BAV）患者存在早期左心室纵向心肌功能障碍，但主动脉瓣狭窄（AS）严重程度对BAV患者多方向心肌功能的影响仍不清楚。本研究的目的是评估BAV患者的多方向心肌功能。
纳入86例左心室射血分数保留（LVEF≥52%）的BAV患者（年龄46.71±13.62岁，男性占69.4%），包括瓣膜功能正常（BAV-nf）、轻度AS、中度AS和重度AS患者。招募30名健康志愿者作为对照组。采用三维斑点追踪超声心动图（3D-STE）进行多方向应变和容积分析。
与对照组相比，BAV-nf患者的整体纵向应变（GLS）和整体径向应变（GRS）降低。从BAV-nf到重度AS，随着AS严重程度的每一类变化，GLS和GRS均出现相关的渐进性损害（均P<0.001）。整体圆周应变（GCS）从BAV-nf到轻度AS未显示出显著下降，但从中度AS开始下降。多元线性回归表明，作为AS严重程度指标的主动脉瓣面积指数（AVA/BSA）是GLS、GCS和GRS的独立决定因素。
即使在二叶式主动脉瓣功能良好的患者中也观察到左心室纵向心肌减少。随着AS严重程度从功能正常到重度主动脉瓣狭窄分级的每一类增加，纵向心肌功能均出现相关的渐进性损害。此外，圆周心肌功能从中度AS开始受损。AVA/BSA与多方向心肌功能损伤独立相关。
