Prognostic implications of left ventricular global longitudinal strain in patients with bicuspid aortic valve disease and preserved left ventricular ejection fraction

William K.F. Kong, E. Mara Vollema, Francesca Prevedello, Rebecca Perry, Arnold C.T. Ng, Kian Keong Poh, Ana G. Almeida, Ariana Gonzalez, Mylène Shen, Tiong Cheng Yeo, Miriam Shanks, Bogdan A. Popescu, Laura Galian Gay, Marcin Fijałkowski, Michael Liang, Ruth W. Chen, Nina Ajmone Marsan, Joseph Selvanayagam, Fausto Pinto, Jose L. ZamoranoPhilippe Pibarot, Arturo Evangelista, Victoria Delgado, Jeroen J. Bax

Research output: Contribution to journalArticlepeer-review

7 Citations (Scopus)


Aims: In patients with bicuspid aortic valve (BAV) and preserved left ventricular (LV) ejection fraction (EF), the frequency of impaired LV global longitudinal strain (GLS) and its prognostic implications are unknown. The present study evaluated the proportion and prognostic value of impaired LV GLS in patients with BAV and preserved LVEF. Methods and results: Five hundred and thirteen patients (68% men; mean age 44 + 18 years) with BAV and preserved LVEF (>50%) were divided into five groups according to the type of BAV dysfunction: (i) normal function BAV, (ii) mild aortic stenosis (AS) or aortic regurgitation (AR), (iii) ≥moderate isolated AS, (iv) ≥moderate isolated AR, and (v) ≥moderate mixed AS and AR. LV systolic dysfunction based on 2D speckle-tracking echocardiography was defined as a cut-off value of LVGLS (-13.6%). The primary outcome was aortic valve intervention or all-cause mortality. The proportion of patients with LVGLS ≤-13.6% was the highest in the normal BAV group (97%) and the lowest in the group with moderate and severe mixed AS and AR (79%). During a median follow-up of 10 years, 210 (41%) patients underwent aortic valve replacement and 17 (3%) died. Patients with preserved LV systolic function (LVGLS ≤ -13.6%) had significantly better event-free survival compared to those with impaired LV systolic function (LVGLS > -13.6%). LVGLS was independently associated with increased risk of events (mainly aortic valve replacement): hazard ratio 1.09; P < 0.001. Conclusion: Impaired LVGLS in BAV with preserved LVEF is not infrequent and was independently associated with increased risk of events (mainly aortic valve replacement events).

Original languageEnglish
Pages (from-to)759-767
Number of pages9
JournalEuropean heart journal cardiovascular Imaging
Issue number7
Publication statusPublished or Issued - 1 Jul 2020
Externally publishedYes


  • bicuspid aortic valve
  • global longitudinal strain
  • prognosis

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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