What is the clinical evidence from this study?

Study design: Case-Control. Population: Thoracic aortic atherosclerosis (n=128). Intervention: Tricuspid aortic valve vs. Bicuspid aortic valve. Primary outcome: Prevalence and severity of atherosclerotic lesions in the ascending aortic wall (OR 1.49, 95% CI 1.14-1.94, p=0.003).

July 19, 2023Open Access

Thoracic aortic atherosclerosis in patients with a bicuspid aortic valve; a case–control study

Q: What does this research mean for the field?

Tricuspid aortic valve patients have significantly more prevalent and severe ascending aortic atherosclerotic lesions compared to bicuspid aortic valve patients. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

ODOnur B. DolmaciOLVG RKRobert J.M. KlautzCardiac Surgery RPRobert E. PoelmannPediatric Cardiology

Key Result

Tricuspid aortic valve patients had significantly more prevalent and severe ascending aortic atherosclerotic lesions compared to bicuspid aortic valve patients (OR 1.49).

Study Design

Type

Case-Control (n=128)

Multicenter

Structured PICO

Does bicuspid aortic valve morphology affect the prevalence and severity of thoracic aortic atherosclerosis compared to tricuspid aortic valve morphology?

Population

128 patients who underwent aortic valve or root replacement between 2006-2020, divided into a histopathology cohort (n=69) and a clinical/CT cohort (n=59).

Intervention

Bicuspid aortic valve (BAV) morphology

Comparator

Tricuspid aortic valve (TAV) morphology

Outcome

Prevalence and severity of thoracic aortic atherosclerosis evaluated histopathologically (AHA classification) and via computed tomography (calcific load)surrogate

Patients with a bicuspid aortic valve have significantly less severe ascending aortic atherosclerosis and coronary calcification compared to those with a tricuspid aortic valve, independent of the presence of a thoracic aortic aneurysm.

Main Result

Effect estimate: OR 1.49 (95% CI 1.14-1.94)

p-value: p=0.003

Limitations

Retrospective and single center design
Relatively small patient samples
Differences in risk profiles were present between the groups

Abstract

INTRODUCTION: Bicuspid aortic valve (BAV) patients have an increased risk to develop thoracic aortic complications. Little is known about the prevalence and severity of atherosclerosis in the BAV ascending aortic wall. This study evaluates and compares the prevalence of thoracic aortic atherosclerosis in BAV and tricuspid aortic valve (TAV) patients. METHODS: Atherosclerosis was objectified using three diagnostic modalities in two separate BAV patient cohorts (with and without an aortic dilatation). Within the first group, atherosclerosis was graded histopathologically according to the modified AHA classification scheme proposed by Virmani et al. In the second group, the calcific load of the ascending aorta and coronary arteries, coronary angiographies and cardiovascular risk factors were studied. Patients were selected from a surgical database (treated between 2006-2020), resulting in a total of 128 inclusions. RESULTS: Histopathology showed atherosclerotic lesions to be more prevalent and severe in all TAV as compared to all BAV patients (OR 1.49 (95%CI 1.14 - 1.94); p = 0.003). Computed tomography showed no significant differences in ascending aortic wall calcification between all BAV and all TAV patients, although a tendency of lower calcific load in favor of BAV was seen. Coronary calcification was higher in all TAV as compared to all BAV (OR 1.30 (95%CI 1.06 - 1.61); p = 0.014). CONCLUSION: Ascending aortic atherosclerotic plaques were histologically more pronounced in TAV as compared to the BAV patients, while CT scans revealed equal amounts of calcific depositions within the ascending aortic wall. This study confirms less atherosclerosis in the ascending aortic wall and coronary arteries of BAV patients as compared to TAV patients. These results were not affected by the presence of a thoracic aortic aneurysm.

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