Journal Article

Comparison of Clinical and Echocardiographic Features of Asymptomatic Patients With Stenotic Bicuspid Versus Tricuspid Aortic Valves

Chen, Ruth, Tan, Benjamin Yong-Qiang, Ho, Jamie Sin-Ying, Chua, Joe Jia-Liang, Sia, Ching-Hui, Yeo, Tiong-Cheng, Ngiam, Nicholas Jinghao, Kong, William Kok-Fai, Chew, Nicholas, Sim, Hui-Wen, Poh, Kian-Keong, Lee, Chi-Hang

2020

Overview

The clinical and imaging differences between bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV) patients with medically managed asymptomatic moderate-to-severe aortic stenosis (AS) have not been studied previously. We aim to characterize these differences and their clinical outcomes in this study. A retrospective observational study was conducted on 836 consecutive cases of isolated asymptomatic moderate-to-severe AS, with median follow-up of 3.4 years. Clinical and echocardiographic characteristics were compared between BAV and TAV patients. Subgroup analysis stratified by AS severity were performed. Survival analysis of all-cause mortality was performed using Kaplan-Meier curves and Cox proportional hazards model. Compared to BAV patients, TAV patients were older (76 ± 11 vs 55 ± 16 years, p <0.001) and had more co-morbidities including hypertension (78% vs 56%; p <0.001), diabetes (41% vs 24%; p <0.001), and chronic kidney disease (20% vs 3%; p = 0.001). TAV patients had less severe aortic valve disease than BAV patients, with a higher aortic valve area index (0.71 ± 0.20 cm2/m2 vs 0.61 ± 0.18 cm2/m2, p <0.001) and less aortic dilation (sinotubular junction: 23.7 ± 4.0 mm vs 26.9 ± 4.8 mm, p <0.001; mid-ascending aorta: 31.4 ± 4.7 mm vs 36.3 ± 6.3 mm, p <0.001). TAV patients were more likely to have eccentric left ventricular hypertrophy and less likely to have a normal geometry (p = 0.003). Competing risk analysis identified increased age (hazard ratio 1.03, 95% confidence interval 1.02 to 1.05, p <0.001) and LVEF (hazard ratio 0.98, 95% confidence interval 0.97 to 0.99, p <0.001) as independent risk factors of all-cause mortality. Valve morphology was not a significant independent risk factor for aortic valve replacement or mortality. In conclusion, asymptomatic TAV patients had more cardiovascular risk factors, less severe aortic valve disease, less sinotubular and mid-ascending aortic dilation, more severe LV remodeling.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adult / Age Factors / Aged / Aged, 80 and over / Aorta / Aortic Diseases - diagnostic imaging / Aortic Diseases - epidemiology / Aortic Diseases - physiopathology / Aortic stenosis / Aortic valve / Aortic Valve - abnormalities / Aortic Valve - diagnostic imaging / Aortic Valve - physiopathology / Aortic Valve Stenosis - complications / Aortic Valve Stenosis - diagnostic imaging / Aortic Valve Stenosis - epidemiology / Aortic Valve Stenosis - physiopathology / Asymptomatic Diseases / Bicuspid Aortic Valve Disease / Cardiovascular disease / Cardiovascular diseases / Case-Control Studies / Cause of Death / Confidence intervals / Diabetes / Diabetes mellitus / Dilatation, Pathologic - diagnostic imaging / Dilatation, Pathologic - epidemiology / Dilatation, Pathologic - physiopathology / Dilation / Echocardiography / Ejection fraction / Female / Geometry / Heart / Heart Valve Diseases - complications / Heart Valve Diseases - diagnostic imaging / Heart Valve Diseases - epidemiology / Heart Valve Diseases - physiopathology / Heart Valve Prosthesis Implantation - statistics & numerical data / Heart valves / Humans / Hypertension / Hypertrophy / Hypertrophy, Left Ventricular - diagnostic imaging / Hypertrophy, Left Ventricular - epidemiology / Hypertrophy, Left Ventricular - physiopathology / Kaplan-Meier Estimate / Kidney diseases / Male / Mathematical morphology / Middle Aged / Morbidity / Morphology / Mortality / Proportional Hazards Models / Retrospective Studies / Risk analysis / Risk Factors / Severity of Illness Index / Statistical models / Stenosis / Stroke / Stroke Volume / Subgroups / Survival analysis / Ventricle