Quantitative imaging in medicine and surgery · 2026
Real-time three-dimensional echocardiographic assessment of the association between aortic diameter and left ventricular mechanical dyssynchrony in patients with bicuspid aortic valve.
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Liu Huan, Guo Xueting, Liu Kunxuan, Li Qinlin, Zhang Caiyun, Liu Kuican, Shi Wenrong, Dong Shanshan, Qin Wenjuan, Huang Lei
Аннотация
BACKGROUND: Bicuspid aortic valve (BAV) is frequently accompanied by aortic dilation (AD), which may impair left ventricular (LV) function. However, research on the relationship between aortic diameter and left ventricular mechanical dyssynchrony (LVMD) is limited. This study aimed to investigate the association between the body surface area (BSA)-indexed aortic size index (ASI) and the three-dimensional systolic dyssynchrony index (3D-SDI) as assessed by real-time three-dimensional echocardiography (RT-3DE) in patients with BAV.
METHODS: This study retrospectively included 79 patients with BAV and 40 normal individuals. Coronary computed tomography angiography (CCTA) was used to measure the internal diameters of the sinus of Valsalva and the ascending aorta in patients with BAV. These measurements were indexed to BSA to calculate the sinus of Valsalva size index (SOVSI) and the ascending aortic size index (AASI), respectively. Patients with BAV were divided into two groups based on the SOVSI and AASI, respectively: the non-dilated group (≤2.1 cm/m²) and the dilated group (>2.1 cm/m²). RT-3DE was used to measure the standard deviation (SD) and maximal difference in the time to minimum systolic volume (Tmsv) across 16, 12, and 6 LV segments. These parameters were expressed as percentages of the cardiac cycle (Tmsv16/12/6-SD% and Tmsv16/12/6-Dif%, respectively). Spearman correlation analysis was conducted to assess the associations between the study variables and Tmsv16-SD%. Multiple linear regression analysis was then performed to identify the factors independently associated with Tmsv16-SD%.
RESULTS: Compared with the controls, patients with BAV exhibited LVMD, as indicated by increased Tmsv16-SD%, Tmsv12-SD%, Tmsv6-SD%, Tmsv16-Dif%, Tmsv12-Dif%, and Tmsv6-Dif%. This increase was more pronounced in the dilated group than in the non-dilated group (P<0.001); however, no significant difference in left ventricular ejection fraction (LVEF) was observed between these two subgroups. Among patients with BAV, those with dilation of the sinus of Valsalva or the ascending aorta also had lower E/A (E, peak early diastolic mitral inflow velocity; A, peak late diastolic mitral inflow velocity) ratios and higher E/e' (e', peak early diastolic mitral annular velocity) ratios. In a multiple linear regression analysis, Tmsv16-SD% was independently associated with SOVSI (β=4.447, P<0.001), AASI (β=3.388, P<0.001), and E/e' (β=0.727, P<0.001).
CONCLUSIONS: Patients with BAV exhibit LVMD, which is more pronounced in those with concomitant AD. Both SOVSI and AASI are independently associated with LVMD. The study findings provide further evidence of an association between AD and greater LVMD in patients with BAV.
METHODS: This study retrospectively included 79 patients with BAV and 40 normal individuals. Coronary computed tomography angiography (CCTA) was used to measure the internal diameters of the sinus of Valsalva and the ascending aorta in patients with BAV. These measurements were indexed to BSA to calculate the sinus of Valsalva size index (SOVSI) and the ascending aortic size index (AASI), respectively. Patients with BAV were divided into two groups based on the SOVSI and AASI, respectively: the non-dilated group (≤2.1 cm/m²) and the dilated group (>2.1 cm/m²). RT-3DE was used to measure the standard deviation (SD) and maximal difference in the time to minimum systolic volume (Tmsv) across 16, 12, and 6 LV segments. These parameters were expressed as percentages of the cardiac cycle (Tmsv16/12/6-SD% and Tmsv16/12/6-Dif%, respectively). Spearman correlation analysis was conducted to assess the associations between the study variables and Tmsv16-SD%. Multiple linear regression analysis was then performed to identify the factors independently associated with Tmsv16-SD%.
RESULTS: Compared with the controls, patients with BAV exhibited LVMD, as indicated by increased Tmsv16-SD%, Tmsv12-SD%, Tmsv6-SD%, Tmsv16-Dif%, Tmsv12-Dif%, and Tmsv6-Dif%. This increase was more pronounced in the dilated group than in the non-dilated group (P<0.001); however, no significant difference in left ventricular ejection fraction (LVEF) was observed between these two subgroups. Among patients with BAV, those with dilation of the sinus of Valsalva or the ascending aorta also had lower E/A (E, peak early diastolic mitral inflow velocity; A, peak late diastolic mitral inflow velocity) ratios and higher E/e' (e', peak early diastolic mitral annular velocity) ratios. In a multiple linear regression analysis, Tmsv16-SD% was independently associated with SOVSI (β=4.447, P<0.001), AASI (β=3.388, P<0.001), and E/e' (β=0.727, P<0.001).
CONCLUSIONS: Patients with BAV exhibit LVMD, which is more pronounced in those with concomitant AD. Both SOVSI and AASI are independently associated with LVMD. The study findings provide further evidence of an association between AD and greater LVMD in patients with BAV.