June 1, 2017Circulation Cardiovascular Imaging
Aortic Cross-Sectional Area/Height Ratio and Outcomes in Patients With Bicuspid Aortic Valve and a Dilated Ascending Aorta
Why the study?
Is an abnormal ascending aortic area/height ratio associated with increased cardiovascular mortality in patients with bicuspid aortic valve and dilated ascending aorta?
Population
969 consecutive patients with bicuspid aortic valve and dilated proximal ascending aorta, mean age 50±13…
Comparison
Abnormal ascending aortic area/height ratio… vs Normal ascending aortic area/height ratio
Design
Cohort
Follow-up
10.8 years (interquartile range, 9.6–12.3)
Authors
Discussion
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Member takes
Implication
May aid risk stratification in bicuspid aortic valve; leaves open whether thresholds should guide intervention timing.
Key Points
- To assess long-term cardiovascular mortality predictors and determine whether indexing proximal ascending aortic area to height provides incremental prognostic value in patients with bicuspid aortic valve.
- Analyzed 969 consecutive patients (mean age 50±13 years; 87% men) with bicuspid aortic valve and ascending aorta ≥4 cm evaluated via gated contrast-enhanced CT or magnetic resonance angiography.
- Calculated aortic cross-sectional area indexed to height, defining an abnormal ratio as ≥10 cm²/m, with follow-up over 10.8 years (IQR 9.6–12.3).
- Cardiovascular death occurred in 82 patients (9%), with an abnormal aortic area/height ratio independently associated with increased mortality (HR 2.00, 95% CI 1.20–3.35, P < 0.01).
- Aortic surgery was associated with significantly improved long-term survival (HR 0.46, 95% CI 0.26–0.80, P < 0.01).
- Among the 405 patients with an aortic diameter of 4.5 to 5.5 cm, 64% had an abnormal area/height ratio, which accounted for 70% of deaths in this subgroup.
Structured PICO
Is an abnormal ascending aortic area/height ratio associated with increased cardiovascular mortality in patients with bicuspid aortic valve and dilated ascending aorta?
P
Population
969 consecutive patients with bicuspid aortic valve and dilated proximal ascending aorta (≥4 cm), mean age 50±13 years, 87% men, who had gated contrast-enhanced thoracic computed tomography or magnetic resonance angiography.
I
Intervention
Abnormal ascending aortic area/height ratio (≥10 cm²/m) measured on tomography
C
Comparator
Normal ascending aortic area/height ratio (<10 cm²/m)
O
Outcome
Cardiovascular mortalityhard clinical
In patients with bicuspid aortic valve and dilated ascending aorta, an ascending aortic area/height ratio ≥10 cm²/m is independently associated with cardiovascular death.
Cite This Study
Masri et al. (2017) studied this question.