Key result
LV mass index ≥113 predicts ~349% higher AV surgery risk alongside LA strain and AS.
Why the study?
Patients with bicuspid aortic regurgitation often do not initially meet guideline criteria for surgery, and early predictors of disease progression are needed to aid risk stratification and surgical timing.
Cohort (n=199)
No
Effect estimate: HR 4.49 (95% CI 1.74 to 11.6)
p-value: p=0.002
Increased LV mass index, impaired LA reservoir strain, and concomitant moderate aortic stenosis are early predictors of surgical progression in patients with significant bicuspid aortic regurgitation without initial surgical indications.
These markers may refine surveillance in bicuspid AR; hypothesis-generating and requires prospective validation before guiding decisions.
BACKGROUND: Bicuspid aortic regurgitation (AR) is common in younger patients who often do not meet guideline-based criteria for aortic valve (AV) surgery at diagnosis. However, identifying early predictors of disease progression may aid in risk stratification and surgical timing. METHODS: From a single-centre registry of 1927 patients with bicuspid AV, we identified 335 patients with moderate or severe AR, excluding those with severe aortic stenosis (AS), endocarditis or other major valvular diseases. Among them, 199 patients (mean age 52±14.0 years; 80% male) did not initially meet the surgical criteria and were included in the final analysis. Clinical data and echocardiographic parameters, including speckle-tracking-derived strain measurements, were analysed. The primary outcome was progression to AV surgery during follow-up. RESULTS: Over a mean follow-up of 4.9 years, 41 patients (21%) underwent AV surgery, primarily for symptom onset or left ventricular (LV) enlargement. In multivariable Cox regression, three independent predictors of future surgery were identified: LV mass index ≥113 g/m² (HR 4.49, 95% CI 1.74 to 11.6, p=0.002), left atrial (LA) reservoir strain <28% (HR 3.07, 95% CI 1.40 to 6.74, p=0.005) and concomitant moderate AS (HR 3.19, 95% CI 1.40 to 7.28, p=0.006). CONCLUSION: In patients with significant bicuspid AR who do not initially meet indications for AV surgery, increased LV mass index, impaired LA reservoir strain and concomitant moderate AS are early predictors of surgical progression. These parameters may enhance surveillance strategies and inform earlier surgical referral in selected patients.
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Lim et al. (2025) conducted a cohort in Bicuspid aortic regurgitation (n=199). Echocardiographic predictors (LV mass index, LA reservoir strain, moderate AS) was evaluated on Progression to AV surgery during follow-up (HR 4.49, 95% CI 1.74 to 11.6, p=0.002). LV mass index ≥113 g/m² (HR 4.49), LA reservoir strain <28% (HR 3.07), and concomitant moderate AS (HR 3.19) were independent early predictors of progression to aortic valve surgery.
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