Left ventricle apical endocardial and epicardial rotation is increased in mild aortic valve insufficiency a preliminary study in athletes with bicuspid aortic avlve .

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71° CONGRESSO NAZIONALE della Società Italiana di Cardiologia

Roma, 11 – 13 dicembre 2010

Purpose : Deformation parameters are recently used to predict subclinical LV dysfunction

in minimally symptomatic patients affected by aortic valve dysfunction. More recently the role of rotation and torsion has been evaluated in aortic stenosis while no data are available on aortic valve insufficiency . Bicuspid Aortic Valve is one of the most common cause of insufficiency in young and in athletes were it remains asymptomatic for along time despite a progressive enlargement of the Left Ventricle chamber ( LV) The aim of this study is to evaluate the role of Endo/Epi rotation and torsion to define the LV performance in two groups of asymptomatic athletes : one with Bicuspid Aortic Valve ( BAV) and mild insufficiency compared to athletes with normal Tricuspid Aortic Valve (TAV). Methods: 30 BAV athletes matched with 30 TAV athletes, were submitted to an echocardiographic exam. The 2D-standard and deformation echo parameters (LV basal and apical Endo/Epi rotation, torsion, circumferential strain) were calculated by the speckle tracking multi-layer approach (X-Strain -ESAOTE-Italy). Statistical analysis includes T-Student pair and unpaired test. Results: The 2D standard echo parameters show significant differences between the two groups: the Ao-Root value (31.11±1.8 BAV_{> 26.22±2.3}TAV_{p<0.05);the IVRT(80.55±9.09}BAV_{> 69.44±7.26}TAV

p <0.01) and LVSD (33.9±2.6 BAV _>30.44±1.5TAV_{p<0.05) .The EF is normal in both (66.29}

±5.2 vs 64.6 ±4.7 p:NS) In BAV only the Epi/Endo apical rotation are significantly higher than TAV (BAV Endo 8.64±4.0 vs TAV 5.89±1.8 with p<0.05; BAV Epi 5.74±1.4 vs TAV Epi 3.40±1.6 p<0.01) but not at basal level (Endo BAV -4.46±2.4 vs Endo TAV -5.95±2.7 p NS ; Epi BAV -4.00±1.2 vs Epi TAV -3.93±2.5 with p NS).Circumferential strain results to be in BAV (Apex Endo -22.20±7.26 ; Epi -13.96±4.30; Base Endo -19.5±4.08; Epi -13.11±4.20) similar to TAV (Apex Endo -26.10±6.96 ;Epi -14.05±4.25 ; Base Endo -21.60±5.89; Epi -13.67±3.59) with p NS for all . In consequence of the low values at basal segments the endo/epi torsion result to be therefore normal in both (Endo Twist BAV 13.51±5.0; Epi Twist BAV 9.45±2.5; Endo Twist TAV 11.80±2.4; Epi Twist TAV 7.31±3.4) Conclusions: The multi-layer approach by 2D speckle tracking imaging provides relevant information on assessment of LV myocardial function in aortic valve insufficiency . Augmented apical endocardial rotation does not contributedto increase the LV twist in BAV. The normal value of the twist in this particular group of athletes could be suggestive, for a possible protective role of the sport activity in them.