Key result
Obesity, diabetes, and cusp fusion link to faster aortic stenosis progression in bicuspid valves.
Why the study?
BAV is associated with faster AS progression, but whether the determinants of AS progression differ between patients with BAV and TAV is unknown.
Do cardiometabolic risk factors accelerate the progression of aortic stenosis differently in patients with bicuspid versus tricuspid aortic valves?
Cohort (n=287)
Do cardiometabolic risk factors accelerate the progression of aortic stenosis differently in patients with bicuspid versus tricuspid aortic valves?
Effect estimate: Standardized β = 0.21 (95% CI 0.04-0.37)
Absolute Event Rate: 0.11% vs 0.12%
p-value: p=0.02
This study suggests that cardiometabolic factors like obesity and diabetes strongly drive aortic stenosis progression in younger patients with bicuspid valves, whereas age-related processes and chronic kidney disease are the primary drivers in patients with tricuspid valves.
Obesity and diabetes may accelerate progression in bicuspid aortic valves; leaves open differential interventions pending prospective trials.
BackgroundBicuspid aortic valve (BAV) is associated with a faster progression of aortic stenosis (AS). Whether the determinants of AS progression are the same or different in patients with BAV vs tricuspid aortic valve (TAV) is unknown. The aim of this study was to identify the factors associated with the progression of AS in patients with BAV vs patients with TAV.MethodsPatients with AS were prospectively recruited in the Metabolic Determinants of the Progression of Aortic Stenosis (PROGRESSA) study (ClinicalTrials.gov Identifier: NCT01679431). The haemodynamic progression rate of AS was assessed by the annualized progression rate of peak aortic jet velocity (Vpeak). Univariable and multivariable linear regression analyses were used to identify the factors associated with a faster progression of AS in patients with BAV vs patients with TAV.ResultsThere were 79 patients with BAV and 208 patients with TAV. The baseline severity of AS was similar between the 2 groups of patients as well as the annualized progression rate of AS. In patients with BAV, obesity (β = 0.25, P = 0.04), diabetes (β = 0.26, P = 0.02), and BAV with right-noncoronary cusp fusion (β = 0.29, P = 0.01) were found to be independently associated with a faster progression of AS, whereas in patients with TAV, AS baseline severity (baseline Vpeak, β = 0.14, P = 0.04) and chronic kidney disease (β = 0.16, P = 0.02) were significantly associated with AS progression.ConclusionFactors associated with progression rate of AS are different in BAV and TAV. The main factors associated with a faster progression of AS appear to be obesity, diabetes, right-noncoronary cusp fusion in patients with BAV vs chronic kidney disease in patients with TAV.
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Shen et al. (2022) conducted a cohort in Aortic Stenosis (n=287). Bicuspid aortic valve (BAV) vs. Tricuspid aortic valve (TAV) was evaluated on Annualized progression rate of peak aortic jet velocity (Vpeak) (Standardized β = 0.21, 95% CI 0.04-0.37, p=0.02). In patients with bicuspid aortic valves, obesity, diabetes, and right-noncoronary cusp fusion were independently associated with faster aortic stenosis progression, whereas chronic kidney disease drove progression in those with tricuspid valves.
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