Predicting Disease Progression in Patients with Bicuspid Aortic Stenosis Using Mathematical Modeling

Kim, Darae; Chae, Dongwoo; Shim, Chi Young; Cho, In‐Jeong; Hong, Geu Ru; Park, Kyungsoo; Ha, Jong‐Won

doi:10.3390/jcm8091302

Cited by 7 publications

(6 citation statements)

References 30 publications

(37 reference statements)

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“…In our analysis, the rapid annual progression of the mean gradient was related to dyslipidemia, diabetes, BAV-LN morphotype, the presence of raphe and basal mean gradient. However, annual progression of the mean gradient is not linear and significantly related to the basal gradient [29] Similarly, progression of AR, in addition to the follow-up interval, was associated with hypertension, dyslipidemia, presence of raphe and basal AR. Michelena et al [7], in a community study, showed age, dyslipidemia and the presence of raphe to be associated with valve degeneration.…”

Section: Discussionmentioning

confidence: 82%

Predictors of Ascending Aorta Enlargement and Valvular Dysfunction Progression in Patients with Bicuspid Aortic Valve

López

Dentamaro

Galian

et al. 2021

JCM

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Bicuspid aortic valve (BAV) patients are at high risk of developing progressive aortic valve dysfunction and ascending aorta dilation. However, the progression of the disease is not well defined. We aimed to assess mid-long-term aorta dilation and valve dysfunction progression and their predictors. Patients were referred from cardiac outpatient clinics to the echocardiographic laboratories of 10 tertiary hospitals and followed clinically and by echocardiography for >5 years. Seven hundred and eighteen patients with BAV (median age 47.8 years [IQR 33–62], 69.2% male) were recruited. BAV without raphe was observed in 11.3%. After a median follow-up of 7.2 years [IQR5–8], mean aortic root growth rate was 0.23 ± 0.15 mm/year. On multivariate analysis, rapid aortic root dilation (>0.35 mm/year) was associated with male sex, hypertension, presence of raphe and aortic regurgitation. Annual ascending aorta growth rate was 0.43 ± 0.32 mm/year. Rapid ascending aorta dilation was related only to hypertension. Variables associated with aortic stenosis and regurgitation progression, adjusted by follow-up time, were presence of raphe, hypertension and dyslipidemia and basal valvular dysfunction, respectively. Intrinsic BAV characteristics and cardiovascular risk factors were associated with aorta dilation and valvular dysfunction progression, taking into account the inherent limitations of our study-design. Strict and early control of cardiovascular risk factors is mandatory in BAV patients.

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Section: Discussionmentioning

confidence: 82%

Predictors of Ascending Aorta Enlargement and Valvular Dysfunction Progression in Patients with Bicuspid Aortic Valve

López

Dentamaro

Galian

et al. 2021

JCM

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“…Recently, the diagnosis of normally functioning BAV in patients without valve dysfunction and aortopathy is increasing. There have been studies on factors that determine valve dysfunction in BAV patients ( 20 – 22 ) or progression in BAV patients with significant valvular dysfunction ( 4 ). Previous studies have also examined how these factors affect left ventricular diastolic function, according to BAV morphology ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

Progression and Outcomes of Non-dysfunctional Bicuspid Aortic Valve: Longitudinal Data From a Large Korean Bicuspid Aortic Valve Registry

Song

Seo

Cho

et al. 2021

Front. Cardiovasc. Med.

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Background: Using echocardiographic surveillance, many patients are diagnosed with bicuspid aortic valve (BAV) without significant valve dysfunction. Limited data are available regarding the progression and outcomes of non-dysfunctional BAV.Methods and Results: We investigated 1,307 BAV patients (984 male, mean age 56 years) diagnosed from Jan 2003 through Dec 2018 in a single tertiary center. Seven hundred sixty-one patients underwent follow-up echocardiography at ≥1 year post-diagnosis. Non-dysfunctional BAV was defined as BAV without moderate aortic stenosis (AS) or aortic regurgitation (AR). The presence of aortopathy was defined as an ascending aorta diameter >37mm. Progression to significant BAV dysfunction, progression to severe aortopathy (ascending aorta diameter ≥45mm), and incidence of valve or aorta operation were analyzed. One hundred eighty-seven (25%) patients showed non-dysfunctional BAV. Among them, 104 (56%) had mild AS or AR, and 81 (43%) had aortopathy at indexed echocardiography. At 6.0 ± 3.8 years post-diagnosis, 56 (29%) progressed to dysfunctional BAV, 28 (15%) progressed to severe aortopathy, 22 (12%) underwent valve operation, and 19 (10%) experienced aorta operation. Eighty-nine percent of patients with normal BAV function and 61% of patients with mild AS or AR maintained non-dysfunctional BAV. More patients with aortopathy progressed to severe aortopathy (35 vs. 0% without aortopathy, p < 0.001), with a higher incidence of aorta operation (21 vs. 2%, p < 0.001).Conclusions: In patients with non-dysfunctional BAV, initial BAV function and degree of aorta dilatation might be important for progression and outcomes. Patients without any dysfunction or aortopathy tend to maintain good structure and function for 6 years.

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“…It is now wellestablished that initial severity is an important predictor of more rapid progression. 6,12,15 As a result, the confounding effect on progression rate introduced by differences in baseline severity between groups may bias the comparison.…”

Section: Discussionmentioning

confidence: 99%

“…However, in both the above studies, the BAV patients differed significantly from TAV patients in terms of baseline AS grade and hemodynamic parameters. It is now well‐established that initial severity is an important predictor of more rapid progression 6,12,15 . As a result, the confounding effect on progression rate introduced by differences in baseline severity between groups may bias the comparison.…”

Section: Discussionmentioning

confidence: 99%

Progression of aortic stenosis in patients with bicuspid aortic valve

Shang

Kahler‐Quesada

Mori

et al. 2021

Journal of Cardiac Surgery

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Background: Bicuspid aortic valve is the most common congenital heart defect and predisposes patients to developing aortic stenosis more frequently and at a younger age than the general population. However, the influence of bicuspid aortic valve on the rate of progression of aortic stenosis remains unclear. Methods: In 236 patients (177 tricuspid aortic valve and 59 bicuspid aortic valve) matched by initial severity of mild or moderate aortic stenosis, we retrospectively analyzed baseline echocardiogram at diagnosis with latest available follow-up echocardiogram. Baseline comorbidities, annualized progression rate of hemodynamic parameters, and hazard of aortic valve replacement were compared between valve phenotypes.Results: Median echocardiographic follow-up was 2.6 (interquartile range [IQR] 1.6-4.2) years. Patients with tricuspid aortic stenosis were significantly older with more frequent comorbid hypertension and congestive heart failure. Median annualized progression rate of mean gradient was 2.3 (IQR 0.6-5.0) mmHg/year versus 1.5 (IQR 0.5-4.1) mmHg/year (p = .5), and that of peak velocity was 0.14 (IQR 0-0.31) m/s/year versus 0.10 (IQR 0.04-0.26) m/s/year (p = .7) for tricuspid versus bicuspid aortic valve, respectively. On multivariate analyses, bicuspid aortic valve was not significantly associated with more rapid progression of aortic stenosis.In a stepwise Cox proportional hazards model adjusted for baseline mean gradient, bicuspid aortic valve was associated with increased hazard of aortic valve replacement (hazard ratio: 1.7, 95% confidence interval [1.0-3.0], p = .049).Conclusion: Bicuspid aortic valve may not significantly predispose patients to more rapid progression of mild or moderate aortic stenosis. Guidelines for echocardiographic surveillance of aortic stenosis need not be influenced by valve phenotype.

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Predicting Disease Progression in Patients with Bicuspid Aortic Stenosis Using Mathematical Modeling

Cited by 7 publications

References 30 publications

Predictors of Ascending Aorta Enlargement and Valvular Dysfunction Progression in Patients with Bicuspid Aortic Valve

Predictors of Ascending Aorta Enlargement and Valvular Dysfunction Progression in Patients with Bicuspid Aortic Valve

Progression and Outcomes of Non-dysfunctional Bicuspid Aortic Valve: Longitudinal Data From a Large Korean Bicuspid Aortic Valve Registry

Progression of aortic stenosis in patients with bicuspid aortic valve

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