Age- and Sex-Related Aortic Valve Dysfunction and Aortopathy Difference in Patients with Bicuspid Aortic Valve

Abstract

Bicuspid aortic valve (BAV) is the most common congenital heart disease. Different distribution of valve dysfunction was found in patients with BAV in different age and sex groups, but related difference was not well established. The aim of our study is to investigate age-and sex-related clinical characteristics differences in patients with BAV. Six hundred twenty patients with BAV who had moderate or severe aortic valve dysfunction were included in the study. Basic clinical data and image data were recorded. Patients were classified into four different age groups: (A: !50 years old; B: 50-60 years old; C: 60-70 years old; D: > 70 years old). The sex-related clinical difference in different age groups was compared. Association between incidence of aortic valve dysfunction and age was evaluated. Male patients had more frequent aortic regurgitation (AR) in patients younger than 70 years old (A: 52.3% versus 20.0%, P = 0.012; B: 43.2% versus 17.8%, P < 0.001; C: 17.0 versus 2.6%, P = 0.002), whereas female patients were more likely to have aortic stenosis (AS) (A: 75.0% versus 34.1%, P = 0.001; B: 77.8% versus 37.0%, P < 0.001; C: 93.6% versus 69.8%, P < 0.001). Frequency of AR in male patients decreased with age, whereas frequency of AS increased. Trend test showed a significant difference in incidence of aortic valve dysfunction as age increased in male patients (AR, P < 0.001; AS, P < 0.001). No trend was found in female patients. Male patients with BAV present more often with moderate/severe AR at a young age, and the frequency of AR decreases with age. Female patients with BAV had more frequent AS at first presentation regardless of age.

Vascular Calcification—New Insights into Its Mechanism

“…Aortic valvular calcification, aortic sclerosis, and aortic stenosis, seen in different stages of calcific aortic valvular disease share a common pathophysiological process [26]. The main cause of calcific aortic valvular disease is age-related degenerative process [27]. In addition, genetic predisposition [28][29][30] such as IL- 10 [31], Lp(a) [28], or apolipoprotein B [32] polymorphism or congenital valvular defects [33] can cause valvular calcification.…”

Aortic stenosis in women

“…However, women with BAV are more likely to develop AS than men, regardless of age of presentation (≤50 years: 75% vs 34%; 51–60 years: 78% vs 37%; 61–70 years: 94% vs 70%). Men ≤70 years with BAV more often present with aortic regurgitation (AR), although the frequency of development of AR in men with BAV decreases with age 6. For tricuspid AV, aortic valve calcification (AVC) evaluated by multidetector CT (MDCT) had good association with haemodynamic severity of AS assessed by Doppler echocardiography (AV area calculated by the continuity equation and mean gradient by the modified Bernoulli equation) in both sexes, but women displayed lower AVC load than men for the same haemodynamic severity, even after adjusting for the smaller BSA or aortic annulus area 7.…”

Demographic Characteristics, BAV Sievers Types, and Interactions Between BAV-Associated Valvulopathy and Aortopathy Differently Affect BAV Comorbidities and Outcomes of Aortic Valve Replacement

“…Age was another independent determinant for BAV valvulopathy. Male BAV patients more often had moderate/severe AR at a young age, and the occurrence of AR decreased with age, while female BAV patients with had higher incidence of AS regardless of age 7 . Valve function was also affected by blood pressure and BAV Sievers type 5 .…”