What is the clinical evidence from this study?

Study design: Cohort. Population: Bicuspid aortic valve (n=227). Intervention: Baseline moderate-severe aortic valve dysfunction. Primary outcome: Composite of interventional and medical cardiac outcomes (HR 3.19, 95% CI 1.35-7.54, p=<0.01).

What question did this study set out to answer?

To evaluate the long-term incidence and predictors of medical and interventional cardiac outcomes in adult patients with bicuspid aortic valve.

December 12, 2016Cardiology in the YoungOpen Access

Bicuspid aortic valve outcomes

Q: What are the key findings of this study?

Baseline moderate-severe aortic valve dysfunction (HR 3.19; 95% CI 1.35-7.54) and calcification (HR 4.72) independently predicted composite cardiac events in adults with bicuspid aortic valves.

Q: What question did this study set out to answer?

To evaluate the long-term incidence and predictors of medical and interventional cardiac outcomes in adult patients with bicuspid aortic valve.

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Key result

Baseline moderate-severe aortic valve dysfunction (HR 3.19; 95% CI 1.35-7.54) and calcification (HR 4.72) independently predicted composite cardiac events in adults with bicuspid aortic valves.

Population

227 ambulatory adults with bicuspid aortic valve followed-up in a tertiary hospital centre

Design

Cohort

Follow-up

13±9 years

Authors

IRInês RodriguesHospital de Santa Marta AAAna AgapitoHospital Curry Cabral LSLídia de SousaCentro Hospitalar de Lisboa Central

Discussion

Member takes

Implication

May inform risk stratification in bicuspid aortic valve adults; hypothesis-generating and requires prospective validation before practice change.

Key Points

To evaluate the long-term incidence and predictors of medical and interventional cardiac outcomes in adult patients with bicuspid aortic valve.
Retrospective cohort analysis of N=227 ambulatory adult patients with bicuspid aortic valve followed for a mean of 13±9 years at a tertiary care center.
Tracked interventional endpoints (aortic valve or thoracic aorta repair), medical endpoints (death, dissection, endocarditis, heart failure, arrhythmia, ischemia), and composite outcomes using Kaplan-Meier and multivariate analyses.
Long-term 20-year survival was 94±2%, yet 38.8% of patients developed at least one cardiac event (20-year cumulative event rate 47±4%), and 33% required aortic valve or thoracic aorta intervention.
Independent predictors of the composite cardiac endpoint were baseline moderate-to-severe aortic valve dysfunction (HR 3.19, 95% CI 1.35–7.54, p<0.01) and aortic valve leaflet calcification (HR 4.72, 95% CI 1.91–11.64, p<0.005).

Study Design

Type

Cohort (n=227)

Multicenter

Structured PICO

Population

227 ambulatory adults with bicuspid aortic valve followed for a mean of 13 years to assess the incidence and predictors of cardiac events.

Outcome

Composite end point of interventional (intervention on the aortic valve or thoracic aorta) and medical (death, aortic dissection, aortic valve endocarditis, congestive heart failure, arrhythmias, or ischaemic heart disease requiring hospital admission) outcomescomposite

Main Result

Hazard Ratio: 3.19 (95% CI 1.35–7.54)

p-value: p=<0.01

In adults with bicuspid aortic valve, long-term survival is excellent but cardiovascular events are frequent, with baseline valve calcification and dysfunction being independent predictors.

Cite This Study

Rodrigues et al. (2016) conducted a cohort in Bicuspid aortic valve (n=227). Baseline moderate-severe aortic valve dysfunction was evaluated on Composite of interventional and medical cardiac outcomes (HR 3.19, 95% CI 1.35-7.54, p=<0.01). Baseline moderate-severe aortic valve dysfunction (HR 3.19; 95% CI 1.35-7.54) and calcification (HR 4.72) independently predicted composite cardiac events in adults with bicuspid aortic valves.

synapsesocial.com/papers/6a71d59da528af2d65c4384d https://doi.org/10.1017/s1047951116002560

Topics

Valvular heart disease

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Implication

May inform risk stratification in bicuspid aortic valve adults; hypothesis-generating and requires prospective validation before practice change.