Key result
Female sex in adults with bicuspid aortic valve was associated with a higher prevalence of the extended aortopathy phenotype compared to men (34.7% vs 23.3%, p=0.001).
Why the study?
Sex-specific patterns of BAV valvulo-aortopathy under consensus phenotyping and the impact of aortic normalisation strategies on sex-related differences remained uncharacterised.
Observational (n=808)
In adults with bicuspid aortic valve, women more frequently exhibit the extended aortopathy phenotype while men have more root phenotype and severe regurgitation, with proximal aortic dimension differences depending heavily on the normalization strategy used.
Sex-specific BAV aortopathy patterns may inform surveillance; leaves open optimal normalization for risk stratification.
Aims To characterise sex-specific patterns of bicuspid aortic valve (BAV) valvulo-aortopathy using consensus phenotyping and to assess how aortic normalisation strategies influence sex-related differences in aortic dimensions. Methods and results We analysed 808 adults with BAV (mean age 49.9 ± 17.5 years; 588 men) from the RE-BAV registry. Valve morphology, aortopathy phenotypes, and clinical valvulo-aortopathy categories were classified according to consensus definitions. Typical and uncomplicated forms were additionally analysed together as a non-complex category. Proximal aortic dimensions were defined as the aortic root and ascending aorta. Valve morphology distribution did not differ by sex. Although the prevalence of aortic dilatation was similar, phenotype distribution differed: women more frequently exhibited the extended phenotype (34.7% vs 23.3%, p = 0.001), whereas the root phenotype was more common in men (15.1% vs 7.8%, p = 0.006). Moderate-to-severe aortic regurgitation was more prevalent in men (50.3% vs 29.1%, p < 0.001). Sex differences in proximal aortic dimensions varied by normalisation strategy. For the ascending aorta, indexing to body surface area yielded larger values in women (21.1 ± 4.0 vs 20.0 ± 4.0 mm/m2, p = 0.001), whereas diameter/height showed no sex-related difference at this level. Conversely, the cross-sectional area-to-height ratio remained higher in men across proximal segments, most prominently at the sinuses of Valsalva (6.9 ± 2.0 vs 5.6 ± 1.6 cm2/m, p < 0.001). Age was independently associated with larger proximal aortic dimensions across all strategies. Conclusion Sex-related differences in BAV involved aortopathy phenotype, aortic regurgitation burden, and proximal aortic dimensions. Interpretation of proximal aortic dimensions depended on the normalisation strategy used, indicating that indexing methods should not be treated as interchangeable.
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Płońska‐Gościniak et al. (2026) conducted an observational in Bicuspid aortic valve (n=808). Female sex vs. Male sex was evaluated on Extended aortopathy phenotype (p=0.001). Female sex in adults with bicuspid aortic valve was associated with a higher prevalence of the extended aortopathy phenotype compared to men (34.7% vs 23.3%, p=0.001).
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