Key result
In patients with repaired aortic coarctation, the presence of a bicuspid aortic valve did not significantly alter left ventricular ejection fraction, volumes, mass, or aortic elasticity compared to a tricuspid aortic valve.
Why the study?
Although about 50% of patients with aortic coarctation have a bicuspid aortic valve, little is known about its impact on left ventricular function and aortic geometry and function in these patients.
Does the presence of a bicuspid aortic valve adversely impact LV and aortic function or geometry in patients with aortic coarctation compared to a tricuspid aortic valve?
Observational (n=93)
No
Does the presence of a bicuspid aortic valve adversely impact LV and aortic function or geometry in patients with aortic coarctation compared to a tricuspid aortic valve?
Absolute Event Rate: 62.3% vs 64.6%
p-value: p=0.28
The presence of a bicuspid aortic valve does not appear to adversely impact left ventricular and aortic function in children and young adults with aortic coarctation.
Does not warrant valve-specific adjustments in post-coarctation monitoring; leaves open need for larger prospective outcome studies.
Background: An isolated bicuspid aortic valve (BAV) is associated with structural and functional abnormalities of the aorta and the left ventricle (LV). Although ~50% of patients with aortic coarctation (CoA) have a BAV, less is known about its impact on LV function and aortic geometry and function in CoA patients. In this cardiovascular magnetic resonance imaging (CMR) study, we analysed markers of LV and aortic function as well as aortic geometry in a large cohort of CoA patients with a BAV and compared them with CoA patients with a tricuspid aortic valve (TAV). Methods: We included 48 patients with a BAV (18.4 ± 9.3 years) and 45 patients with TAV (20.7 ± 9.9 years). LV volumes, mass and ejection fraction as well as aortic distensibilty, pulse wave velocity (PWV) were measured from standard cine CMR and phase-contrast CMR images. 2-dimensional CMR feature tracking (2DCMR-FT) was performed to measure longitudinal, circumferential and radial strain and strain rate of the LV. Aortic arch geometry was classified as romanic, gothic and crenel. Results: LV volumes, mass and ejection fraction as well as aortic distensibility and PWV did not significantly differ between the BAV and the TAV group. There was also no significant difference for LV global longitudinal, radial and circumferential strain and strain rate between both groups. Patients with a BAV had more commonly a gothic aortic arch compared to TAV patients, but this difference was not statistically significant (22 vs. 14, p = 0.2). Ascending and descending aortic distensibility correlated with LV mass in the entire patient group (p < 0.001). Global longitudinal, circumferential and radial strain (GLS, GCS, GRS) and global longitudinal and circumferential strain rate (GLSR, GCSR) correlated with LV ejection fraction (p < 0.001). Conclusion: Our data suggest that the presence of a BAV does not adversely impact LV and aortic function in children and young adults with CoA. The correlation of global circumferential, longitudinal and radial strain values with LV ejection fraction demonstrates that 2D-CMR-FT might provide additional information related to ventricular function in CoA patients.
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Schweikert et al. (2021) conducted an observational in Aortic coarctation (n=93). Bicuspid aortic valve vs. Tricuspid aortic valve was evaluated on Left ventricular ejection fraction (%) (p=0.28). In patients with repaired aortic coarctation, the presence of a bicuspid aortic valve did not significantly alter left ventricular ejection fraction, volumes, mass, or aortic elasticity compared to a tricuspid aortic valve.
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