In severe aortic stenosis, bicuspid valves had higher fibrotic scores than tricuspid valves (204 vs. 144 mm3/cm2, P=0.006), with women showing a greater fibro-calcific ratio than men.
Observational (n=140)
Does bicuspid valve morphology influence quantitative aortic valve composition compared to tricuspid morphology in patients with severe aortic stenosis?
In severe aortic stenosis, bicuspid valves exhibit proportionately more fibrosis than tricuspid valves, particularly in women, highlighting sex- and morphology-specific differences in valve pathophysiology.
Absolute Event Rate: 204% vs 144%
p-value: p=0.006
AIMS: Aortic stenosis is characterized by fibrosis and calcification of the valve, with a higher proportion of fibrosis observed in women. Stenotic bicuspid aortic valves progress more rapidly than tricuspid valves, which may also influence the relative composition of the valve. We aimed to investigate the influence of cusp morphology on quantitative aortic valve composition quantified from contrast-enhanced computed tomography angiography in severe aortic stenosis. METHODS AND RESULTS: Patients undergoing transcatheter aortic valve implantation with bicuspid and tricuspid valves were propensity matched 1:1 by age, sex, and comorbidities. Computed tomography angiograms were analysed using semi-automated software to quantify the fibrotic and calcific scores (volume/valve annular area) and the fibro-calcific ratio (fibrotic score/calcific score). The study population (n = 140) was elderly (76 ± 10 years, 62% male) and had a peak aortic jet velocity of 4.1 ± 0.7 m/s. Compared with those with tricuspid valves (n = 70), patients with bicuspid valves (n = 70) had higher fibrotic scores 204 (interquartile range 118-267) vs. 144 (99-208) mm3/cm2, P = 0.006 with similar calcific scores (P = 0.614). Women had greater fibrotic scores than men in bicuspid 224 (181-307) vs. 169 (109-247) mm3/cm2, P = 0.042 but not tricuspid valves (P = 0.232). Men had greater calcific scores than women in both bicuspid 203 (124-355) vs. 130 (70-182) mm3/cm2, P = 0.008 and tricuspid 177 (136-249) vs. 100 (62-150) mm3/cm2, P = 0.004 valves. Among both valve types, women had a greater fibro-calcific ratio compared with men tricuspid 1.86 (0.94-2.56) vs. 0.86 (0.54-1.24), P = 0.001 and bicuspid 1.78 (1.21-2.90) vs. 0.74 (0.44-1.53), P = 0.001. CONCLUSIONS: In severe aortic stenosis, bicuspid valves have proportionately more fibrosis than tricuspid valves, especially in women.
Patel et al. (Tue,) conducted a observational in Severe aortic stenosis (n=140). Bicuspid aortic valves vs. Tricuspid aortic valves was evaluated on Fibrotic score (mm3/cm2) (p=0.006). In severe aortic stenosis, bicuspid valves had higher fibrotic scores than tricuspid valves (204 vs. 144 mm3/cm2, P=0.006), with women showing a greater fibro-calcific ratio than men.