Reduced artery elasticity and reduced myocardial strain were present in patients with bicuspid aortic valve (BAV). Their relation to dilation of proximal aorta is unclear. We aimed to study their relation to dilation of proximal aorta. We studied 57 BAV patients categorized into 2 subgroup according to proximal ascending aortic dimensions (nondilated < 35 mm and dilated aeyen35 mm). Twenty-nine healthy subjects were recruited as control. Aortic and carotid strain, distensibility and stiffness index were derived. Left ventricular myocardial strain were acquired with speckle-tracking echocardiography. BAV patients with dilation of proximal ascending aorta had lower aortic strain (4.1 +/- 4.2 % vs. 7.1 +/- 3.5 %) and carotid strain (4.8 +/- 1.9 % vs. 10.6 +/- 4.2 %), lower aortic distensibility (1.4 +/- 1.5 cm(2) dyn(-1) 10(-6) vs. 2.5 +/- 1.5 cm(2) dyn(-1) 10(-6)) and carotid distensibility (1.6 +/- 0.7 cm(2) dyn(-1) 10(-6) vs. 3.9 +/- 2.4 cm(2) dyn(-1) 10(-6)), higher aortic stiffness index (19.7 +/- 14.1 vs. 8.3 +/- 4.9) and carotid stiffness index (12.2 +/- 8.5 vs. 5.0 +/- 2.2), and lower global circumferential (-15.9 +/- 5.8 % vs. -19.1 +/- 4.1 %), radial (19.3 +/- 11.6 % vs. 29.8 +/- 14.9 %) and longitudinal (-15.7 +/- 3.4 % vs. -18.4 +/- 3.4 %) compared with those without dilation of proximal ascending aorta. All mean values are different to p < 0.05. Dilation of proximal ascending aorta is associated with more advanced reduction of aortic and carotid elasticity and myocardial strain in BAV patients, supporting the need for detailed and extensive vascular and cardiac surveillance in BAV patients.