Left atrial strain brings new insights for evaluating early diastolic dysfunction in patients with well-functioning bicuspid aortic valve

Background: Left atrial reservoir strain (LARS) is an early sensor of left ventricular (LV) diastolic dysfunction. Still, the clinical implications of LARS in patients with well-functioning bicuspid aortic valve (BAV) remain unknown.Materials: The study recruited 103 patients with well-functioning BAV and 50 controls with tricuspid aortic valves. LARS, LV global longitudinal strain (LVGLS) and aortic elasticity indices (aortic strain, aortic distensibility and stiffness index) were acquired. This study aimed to analyze the changes of LARS and further explore the influential factors of LARS in patients with well-functioning BAV.Results: Patients with BAV had lower LARS (34.17 +/- 4.85 vs. 44.72 +/- 6.06 %, P < .001) and LVGLS (20.53 +/- 1.28 vs. 22.30 +/- .62 %, P < .001), and abnormal aortic elasticity indices (aortic strain:7.14 +/- 1.57 vs. 10.99 +/- 1.03 %, aortic distensibility: 5.82 +/- 1.50 vs. 8.98 +/- 2.42 (10(-6) cm(2) dyne(-1)), and stiffness index: 6.30 +/- 2.30 vs. 3.92 +/- .98, all P < .05) compared with controls. LARS was associated with LVGLS (r = .799), interventricular septum index (r = -.232), lateral e' (r = .290), septal e' (r = .308), E/e' ratio (r = -.392), aortic strain (r = .829), aortic distensibility (r = .361), and stiffness index (r = -.724) (all P < .05). LVGLS, aortic strain and E/e' ratio were independent influencers of LARS in the multifactorial analysis model (all P < .05).Conclusion: In patients with well-functioning BAV, decreased LARS may provide evidence of subclinical LV diastolic function impairment. LARS may be helpful for clinical risk stratification in such a population.