Utilizing Global Longitudinal Strain (GLS) to Guide Safe Exercise Prescription and Physical Rehabilitation in Pediatric BAV Patients

Abstract

Bicuspid aortic valve (BAV) is one of the most common congenital heart defects in children and is frequently associated with progressive valvular dysfunction and aortopathy. Conventional assessment using left ventricular ejection fraction (LVEF) may fail to detect early myocardial impairment. Despite increasing clinical application of speckle tracking echocardiography (STE), limited pediatric evidence exists regarding the prognostic value of global longitudinal strain (GLS) for identifying subclinical left ventricular dysfunction and guiding early clinical decision-making in BAV patients. This study provides an analytical evaluation of recent pilot evidence assessing GLS in pediatric BAV patients, with emphasis on segmental strain abnormalities and phenotype-specific risk stratification through STE-derived measurements. The evidence indicates that GLS is more sensitive than LVEF in detecting subtle myocardial dysfunction even when global systolic performance appears preserved. Segmental strain reductions, particularly in inferior, anterior, and apical regions, were identified as early indicators of myocardial alteration. Integration of GLS into routine pediatric BAV assessment may enhance early risk stratification, support safe exercise prescription, and enable personalized monitoring strategies. Nevertheless, larger multi-center longitudinal investigations are necessary to validate GLS as a standardized prognostic marker in pediatric cardiology practice.