{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T00:10:23Z","timestamp":1782605423503,"version":"3.54.5"},"reference-count":41,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2024,12,13]],"date-time":"2024-12-13T00:00:00Z","timestamp":1734048000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"George Emil Palade Univ Med Pharm Sci&amp;Technol. of T\u00e2rgu Mure\u0219","award":["163\/1\/10.01.2023"],"award-info":[{"award-number":["163\/1\/10.01.2023"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Bicuspid aortic valve (BAV) is a prevalent congenital heart defect that continues to present a significant challenge in the management of paediatric patients. The assessment of left ventricle systolic function is typically conducted through the measurement of the left ventricular ejection fraction. Currently, left ventricle global longitudinal strain (LV GLS) is regarded as a more sensitive indicator, enabling the quantitative assessment of global and segmental ventricular function through the determination of myocardial deformation. Methods: A prospective study was conducted between 10 January 2023 and 10 January 2024 in a tertiary paediatric cardiology referral centre. The study enrolled children aged 6 to 17 years with BAV who were undergoing periodic evaluation, as well as a control group. The primary objective was to analyse the systolic function (global and segmental LV) using the classical method (LV EF) and speckle tracking echocardiography (STE). Results: The study group comprised 73 patients with a mean age of 13 years and was predominantly male. The control group comprised 55 patients. The phenotype IB with aortic regurgitation (AR) was the most prevalent. The results of the STE evaluation in the control group demonstrated mean GLS values between \u221222.1% and \u221222.8%. A comparison of the BAV group and the control group revealed a significant difference in GLS for the apical four-chamber view (p = 0.022). Conclusions: Although the analysis of global LV function demonstrated normal values of EF in patients with BAV, the strain analysis revealed significantly reduced strain in the inferior segment and in the apical four-chamber view, as well as in the anterior segment. Further investigation is required to determine whether reduced LV GLS in paediatric patients with BAV will ultimately result in the development of clinical heart failure. Additionally, it is necessary to ascertain whether this can identify patients with subclinical heart failure and whether early detection can result in a reduction in morbidity.<\/jats:p>","DOI":"10.3390\/children11121514","type":"journal-article","created":{"date-parts":[[2024,12,13]],"date-time":"2024-12-13T06:53:39Z","timestamp":1734072819000},"page":"1514","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Speckle Strain Analysis of Left Ventricular Dysfunction in Paediatric Patients with Bicuspid Aortic Valve\u2014A Pilot Study"],"prefix":"10.3390","volume":"11","author":[{"given":"Amalia","family":"F\u0103g\u0103r\u0103\u0219an","sequence":"first","affiliation":[{"name":"Department of Pediatrics III, Faculty of Medicine, George Emil Palade Univ Med Pharm Sci&Technol. of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"},{"name":"Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of T\u00e2rgu Mure\u0219, Gheorghe Marinescu Street No. 50, 540136 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simina-Elena","family":"Ghiragosian-Rusu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics III, Faculty of Medicine, George Emil Palade Univ Med Pharm Sci&Technol. of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"},{"name":"Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of T\u00e2rgu Mure\u0219, Gheorghe Marinescu Street No. 50, 540136 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudiu","family":"Ghiragosian","sequence":"additional","affiliation":[{"name":"Department of Surgery IV, George Emil Palade Univ Med Pharm Sci&Technol. of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liliana","family":"Gozar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics III, Faculty of Medicine, George Emil Palade Univ Med Pharm Sci&Technol. of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"},{"name":"Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of T\u00e2rgu Mure\u0219, Gheorghe Marinescu Street No. 50, 540136 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen","family":"Suteu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics III, Faculty of Medicine, George Emil Palade Univ Med Pharm Sci&Technol. of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"},{"name":"Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of T\u00e2rgu Mure\u0219, Gheorghe Marinescu Street No. 50, 540136 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniela","family":"Toma","sequence":"additional","affiliation":[{"name":"Department of Pediatrics III, Faculty of Medicine, George Emil Palade Univ Med Pharm Sci&Technol. of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"},{"name":"Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of T\u00e2rgu Mure\u0219, Gheorghe Marinescu Street No. 50, 540136 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia Cristina","family":"Al-Akel","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiology, Emergency Institute for Cardiovascular Diseases and Transplantation of T\u00e2rgu Mure\u0219, Gheorghe Marinescu Street No. 50, 540136 T\u00e2rgu Mure\u0219, Romania"},{"name":"Pathophysiology Department, Faculty of Medicine in English, George Emil Palade Univ Med Pharm Sci&Technol. of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2498-5433","authenticated-orcid":false,"given":"Manuela","family":"Cucerea","sequence":"additional","affiliation":[{"name":"Department of Neonatology, George Emil Palade Univ Med Pharm Sci&Technol. of T\u00e2rgu Mure\u0219, 540142 T\u00e2rgu Mure\u0219, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Xiong, T.-Y., Sondergard, L., Mylotte, D., Piazza, N., Prendergast, B., and Chen, M. (2023). Editorial: Bicuspid aortic valve: From pathophysiological mechanisms, imaging diagnosis to clinical treatment methods. Front. Cardiovasc. Med., 10.","DOI":"10.3389\/fcvm.2023.1193544"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1016\/j.amjcard.2003.11.031","article-title":"An echocardiographic survey of primary school children for bicuspid aortic valve","volume":"93","author":"Basso","year":"2004","journal-title":"Am. J. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"101636","DOI":"10.1016\/j.ppedcard.2023.101636","article-title":"Left ventricular strain in pediatric patients with bicuspid aortic valves and aortopathy","volume":"69","author":"Frye","year":"2023","journal-title":"Prog. Pediatr. Cardiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1002\/cjp2.21","article-title":"The pathology and pathobiology of bicuspid aortic valve: State of the art and novel research perspectives","volume":"1","author":"Mathieu","year":"2015","journal-title":"J. Pathol. Clin. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2354","DOI":"10.1016\/j.ultrasmedbio.2023.07.012","article-title":"Flow Dynamics in Children with Bicuspid Aortic Valve: A Blood Speckle Tracking Study","volume":"49","author":"Henry","year":"2023","journal-title":"Ultrasound Med. Biol."},{"key":"ref_6","first-page":"e67372","article-title":"Histidine-Tryptophan-Ketoglutarate Cardioplegia Yields Different Results in Aortic Valve Surgery Depending on Patient Gender: A Pilot Study","volume":"16","author":"Ghiragosian","year":"2024","journal-title":"Cureus"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Anastasiou, V., Daios, S., and Bazmpan, M.A. (2023). Shifting from Left Ventricular Ejection Fraction to Strain Imaging in Aortic Stenosis. Diagnostics, 13.","DOI":"10.3390\/diagnostics13101756"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1207","DOI":"10.1016\/j.ultrasmedbio.2013.02.015","article-title":"Left Ventricular Longitudinal Strain Measured by Speckle Tracking as a Predictor of the Decrease in Left Ventricular Deformation in Children with Congenital Stenosis of the Aorta or Coarctation of the Aorta","volume":"39","author":"Antona","year":"2013","journal-title":"Ultrasound Med. Biol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"38","DOI":"10.21037\/pm-21-39","article-title":"Echocardiographic strain imaging: What do paediatric cardiologists need to know?","volume":"5","author":"Cheung","year":"2022","journal-title":"Pediatr. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"767","DOI":"10.2459\/JCM.0000000000001213","article-title":"Chest conformation spuriously influences strain parameters of myocardial contractile function in healthy pregnant women","volume":"22","author":"Sonaglioni","year":"2021","journal-title":"J. Cardiovasc. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.echo.2015.11.016","article-title":"Reference Ranges of Left Ventricular Strain Measures by Two-Dimensional Speckle-Tracking Echocardiography in Children: A Systematic Review and Meta-Analysis","volume":"29","author":"Levy","year":"2016","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/s12947-015-0029-0","article-title":"Normal ranges of left ventricular strain in children: A meta-analysis","volume":"13","author":"Jashari","year":"2015","journal-title":"Cardiovasc. Ultrasound"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e005942","DOI":"10.1161\/CIRCIMAGING.116.005942","article-title":"Incremental Prognostic Use of Left Ventricular Global Longitudinal Strain in Asymptomatic\/Minimally Symptomatic Patients with Severe Bioprosthetic Aortic Stenosis Undergoing Redo Aortic Valve Replacement Circulation","volume":"10","author":"Naji","year":"2017","journal-title":"Cardiovasc. Imaging"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1669","DOI":"10.1093\/ehjci\/jeab284","article-title":"Left ventricular remodelling in bicuspid aortic valve disease","volume":"23","author":"Butcher","year":"2022","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1016\/j.pcad.2020.06.006","article-title":"Speaking a Common Language: Introduction to a Standard Terminology for the Bicuspid Aortic Valve and Its Aortopathy","volume":"63","author":"Michelena","year":"2020","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.echo.2023.11.015","article-title":"Guidelines for Performing a Comprehensive Pediatric Transthoracic Echocardiogram: Recommendations from the American Society of Echocardiography","volume":"37","author":"Lopez","year":"2024","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1016\/j.jjcc.2016.03.010","article-title":"Nomograms for Two-Dimensional Echocardiography Derived Valvular and Arterial Dimensions in Caucasian Children","volume":"69","author":"Cantinotti","year":"2017","journal-title":"J. Cardiol."},{"key":"ref_18","unstructured":"R Core Team (2024). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"F\u0103g\u0103r\u0103\u0219an, A., S\u0103s\u0103ran, M., Gozar, L., Toma, D., \u0218uteu, C., Ghiragosian-Rusu, S.-E., Al-Akel, F.-C., Szabo, B., and Hu\u021banu, A. (2024). Circulating Matrix Metalloproteinases for Prediction of Aortic Dilatation in Children with Bicuspid Aortic Valve: A Single-Center, Observational Study. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms251910538"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2008.11.029","article-title":"Echocardiographic Assessment of Valve Stenosis: EAE\/ASE Recommendations for Clinical Practice","volume":"22","author":"Baumgartner","year":"2009","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS Guidelines for the Management of Valvular Heart Disease: Developed by the Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40124-024-00336-4","article-title":"Giacone, Protecting Young Hearts: Sports Clearance for Young Patients at Risk for Sudden Cardiac Death","volume":"13","author":"Pulapaka","year":"2024","journal-title":"Curr. Pediatr. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Senekovi\u010d Kojc, T., and Mar\u010dun Varda, N. (2022). Novel Biomarkers of Heart Failure in Pediatrics. Children, 9.","DOI":"10.3390\/children9050740"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"100119","DOI":"10.1016\/j.shj.2022.100119","article-title":"The Natural History of Bicuspid Aortic Valve Disease","volume":"7","author":"Kusner","year":"2023","journal-title":"Struct. Heart"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1111\/echo.15668","article-title":"Impact of aortic valve stenosis on myocardial deformation in different left ventricular levels: A three-dimensional speckle tracking echocardiography study","volume":"40","author":"Hjertaas","year":"2023","journal-title":"Echocardiography"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Spaziani, G., Girolami, F., Arcieri, L., Calabri, G.B., Porcedda, G., Di Filippo, C., Surace, F.C., Pozzi, M., and Favilli, S. (2022). Bicuspid Aortic Valve in Children and Adolescents: A Comprehensive Review. Diagnostics, 12.","DOI":"10.3390\/diagnostics12071751"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Baba, D.F., Suciu, H., Avram, C., Danilesco, A., Moldovan, D.A., Rauta, R.C., Huma, L., and Sin, I.A. (2023). The Role of Preoperative Chronic Statin Therapy in Heart Transplant Receipts\u2014A Retrospective Single-Center Cohort Study. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20043471"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1007\/s00246-017-1781-8","article-title":"Impact of bicuspid aortic valve morphology on aortic valve disease and aortic dilation in pediatric patients","volume":"39","author":"Ward","year":"2018","journal-title":"Pediatr. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Liu, T., Xie, M., Lv, Q., Li, Y., Fang, L., Zhang, L., Deng, W., and Wang, J. (2019). Bicuspid Aortic Valve: An Update in Morphology, Genetics, Biomarker, Complications, Imaging Diagnosis and Treatment. Front. Physiol., 9.","DOI":"10.3389\/fphys.2018.01921"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1920","DOI":"10.1056\/NEJMra1207059","article-title":"Aortic dilatation in patients with bicuspid aortic valve","volume":"370","author":"Verma","year":"2014","journal-title":"N. Engl. J. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1111\/chd.12591","article-title":"Disease progression and variation in clinical practice for isolated bicuspid aortic valve in children","volume":"13","author":"Yamauchi","year":"2018","journal-title":"Congenit. Heart Dis."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e009675","DOI":"10.1161\/CIRCIMAGING.119.009675","article-title":"Long-term risk factors for dilatation of the proximal aorta in a large cohort of children with bicuspid aortic valve","volume":"13","author":"Blais","year":"2020","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.ijcard.2014.10.089","article-title":"Left ventricular response to pressure afterload in children: Aortic stenosis and coarctation: A systematic review of the current evidence","volume":"178","author":"Jashari","year":"2015","journal-title":"Int. J. Cardiol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"264","DOI":"10.4103\/aca.aca_35_21","article-title":"Assessment of Cardiac Function in Children by Strain Imaging and its Correlation with Conventional Echocardiographic Parameter","volume":"25","author":"Chatterjee","year":"2022","journal-title":"Ann. Card. Anaesth."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2399","DOI":"10.1007\/s10554-021-02215-1","article-title":"Aortic strain in bicuspid aortic valve: An analysis","volume":"37","author":"Carlos","year":"2021","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Godlewski, K., Dry\u017cek, P., Sadurska, E., and Werner, B. (2021). Left ventricular systolic function impairment in children after balloon valvuloplasty for congenital aortic stenosis assessed by 2D speckle tracking echocardiography. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0248862"},{"key":"ref_37","unstructured":"Salcedo, E.E., and Gill, E.A. (2021). Clinical Applications of Strain Imaging in Aortic Valve Disease, IntechOpen."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/j.jcmg.2017.02.016","article-title":"Incremental prognostic utility of left ventricular global longitudinal strain in asymptomatic patients with significant chronic aortic regurgitation and preserved left ventricular ejection fraction","volume":"11","author":"Alashi","year":"2018","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Marigliano, A.-N., Ortiz, J.-T., Casas, J., and Evangelista, A. (2024). Aortic Regurgitation: From Valvular to Myocardial Dysfunction. J. Clin. Med., 13.","DOI":"10.3390\/jcm13102929"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1007\/s10554-016-0838-8","article-title":"Quantitative assessment of systolic left ventricular function with speckle-tracking echocardiography in adult patients with repaired aortic coarctation","volume":"32","author":"Menting","year":"2016","journal-title":"Int. J. Cardiovasc. Imaging"}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/12\/1514\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:54:34Z","timestamp":1760115274000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/11\/12\/1514"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,13]]},"references-count":41,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["children11121514"],"URL":"https:\/\/doi.org\/10.3390\/children11121514","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,13]]}}}