Key result
Clinical model using palpitations, AFib, and hypertension predicts BAV with AUC ~0.67.
Why the study?
Bicuspid aortic valve disease is the most common congenital heart condition, and early detection can improve outcomes for patients.
Do clinical features such as palpitations, atrial fibrillation, and hypertension predict a diagnosis of bicuspid aortic valve disease in primary care?
Case-Control
Do clinical features such as palpitations, atrial fibrillation, and hypertension predict a diagnosis of bicuspid aortic valve disease in primary care?
Effect estimate: AUC 0.669 (95% CI 0.658-0.680)
Clinical features such as palpitations, atrial fibrillation, and hypertension in primary care should raise clinical suspicion for bicuspid aortic valve disease and prompt echocardiography screening.
May support heightened BAV suspicion in primary care but should not yet change practice; leaves open need for prospective model validation.
Bicuspid aortic valve disease (BAV) is the most common congenital heart condition, and early detection can improve outcomes for patients. In this case−control study, patients with a diagnosis of BAV were identified from their electronic primary-care records in the UK’s Clinical Practice Research Datalink (CPRD). Each case was propensity-score matched to up to five controls. The clinical features recorded before diagnosis were compared. The proposed clinical features shown to be associated with BAV (p < 0.05) were incorporated into a multivariable regression model. We identified 2898 cases. The prevalence of BAV in the CPRD was 1 in 5181, significantly lower than expected, suggesting that diagnosis and/or recording could be improved. The following biologically plausible clinical features were associated with a subsequent diagnosis of BAV: palpitations (OR: 2.86 (95% CI: 1.60, 3.16)), atrial fibrillation (AF) (OR: 2.25 (95% CI: 1.60, 3.16)) and hypertension (OR: 1.72 (1.48, 2.00)). The best model had an AUC of 0.669 (95% CI: 0.658 to 0.680), a positive predictive value (PPV) of 5.9% (95% CI: 4.0% to 8.7%) and a negative predictive value (NPV) of 99% (95% CI: 99% to 99%) at a population prevalence of 1%. This study indicates that palpitations, hypertension and AF should trigger a clinical suspicion of BAV and assessment via echocardiography. It also demonstrates the potential to develop a prediction model for BAV to stratify patients for echocardiography screening.
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Evans et al. (2022) conducted a case-control in Bicuspid aortic valve disease (BAV). Clinical features and prediction model vs. Matched controls without BAV was evaluated on Diagnosis of BAV (prediction model performance) (AUC 0.669, 95% CI 0.658-0.680). A multivariable prediction model incorporating clinical features such as palpitations, atrial fibrillation, and hypertension predicted bicuspid aortic valve disease with an AUC of 0.669.
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