Why the study?
Stenotic bicuspid aortic valves progress more rapidly than tricuspid valves, which may influence relative valve composition, but the influence of cusp morphology on quantitative aortic valve composition was unclear.
Does bicuspid valve morphology influence quantitative aortic valve composition compared to tricuspid morphology in patients with severe aortic stenosis?
Observational (n=140)
Does bicuspid valve morphology influence quantitative aortic valve composition compared to tricuspid morphology in patients with severe aortic stenosis?
Absolute Event Rate: 204% vs 144%
p-value: p=0.006
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.
Bicuspid morphology was associated with greater fibrosis in severe aortic stenosis; leaves open whether imaging or therapies should differ by valve type or sex.
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.
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Patel et al. (2023) conducted an observational in Severe aortic stenosis (n=140). Bicuspid aortic valves vs. Tricuspid aortic valves was evaluated on Fibrotic score (mm3/cm2) (p=0.006).
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