Key result
BAV stenosis is linked to ~9-fold higher odds of larger LVOT diameter vs. TAV.
Why the study?
Differences in left ventricular morphological and functional parameters between bicuspid and tricuspid aortic valve stenosis patients undergoing AVR surgery were not well characterized.
Do left ventricular morphological and functional parameters differ between patients with bicuspid versus tricuspid aortic valve stenosis undergoing aortic valve replacement?
Observational (n=190)
Do left ventricular morphological and functional parameters differ between patients with bicuspid versus tricuspid aortic valve stenosis undergoing aortic valve replacement?
Odds Ratio: 9 (95% CI 1–81.3)
Absolute Event Rate: 21.7% vs 18.9%
p-value: p=0.04
Preoperative cardiac MRI reveals significant morphological differences, including larger LVOT diameters and LV volumes, in patients with bicuspid compared to tricuspid aortic valve stenosis.
Larger LVOT in bicuspid AS may affect pre-AVR planning; leaves open differential remodeling effects and requires prospective validation.
Objectives: Prospective analysis of left ventricular (LV) morphological/functional parameters in patients with bicuspid versus tricuspid aortic valve (TAV) stenosis undergoing aortic valve replacement (AVR) surgery. Methods: A total of 190 consecutive patients with BAV ( n = 154) and TAV stenosis ( n = 36) (mean age 61 ± 8 years, 65% male) underwent AVR ± concomitant aortic surgery from January 2012 through May 2015. All patients underwent preoperative cardiac magnetic resonance imaging in order to evaluate: (i) left ventricular outflow tract (LVOT) dimensions, (ii) length of anterior mitral leaflet (AML), (iii) end-systolic and end-diastolic LV wall thickness, (iv) LV area, (v) LV end-systolic and end-diastolic diameters (LVESD, LVEDD), (vi) LV end-diastolic and end-systolic volumes (LVEDV, LVESV) and (vii) maximal diameter of aortic root. These parameters were compared between the two study groups. Results: The LVOT diameter was significantly larger in BAV patients (21.7 ± 3 mm in BAV vs 18.9 ± 3 mm in TAV, P < 0.001). Moreover, BAV patients had significantly longer AML (24 ± 3 mm in BAV vs 22 ± 4 mm in TAV, P = 0.009). LVEDV and LVESV were significantly larger in BAV patients (LVEDV: 164.9 ± 68.4 ml in BAV groups vs 126.5 ± 53.1 ml in TAV group, P = 0.037; LVESV: 82.1 ± 57.9 ml in BAV group vs 52.9 ± 25.7 ml in TAV group, P = 0.008). A strong linear correlation was found between LVOT diameter and aortic annulus diameter in BAV patients ( r = 0.7, P < 0.001), whereas significantly weaker correlation was observed in TAV patients ( r = 0.5, P = 0.006, z = 1.65, P = 0.04). Presence of BAV morphology was independently associated with larger LVOT diameters (OR 9.0, 95% CI 1.0-81.3, P = 0.04). Conclusions: We found relevant differences in LV morphological/functional parameters between BAV and TAV stenosis patients. Further investigations are warranted in order to determine the cause of these observed differences.
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Disha et al. (2016) conducted an observational in Aortic valve stenosis (n=190). Bicuspid aortic valve (BAV) morphology vs. Tricuspid aortic valve (TAV) morphology was evaluated on Larger left ventricular outflow tract (LVOT) diameter (OR 9.0, 95% CI 1.0-81.3, p=0.04). Bicuspid aortic valve morphology was independently associated with larger left ventricular outflow tract diameters compared to tricuspid aortic valves (OR 9.0; 95% CI 1.0-81.3; P=0.04).
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