Lee Soo Youn, Shim Chi Young, Kim Darae, Cho Iksung, Hong Geu-Ru, Ha Jong-Won, Chung Namsik
Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea; Department of Cardiology, Sejong General Hospital, Bucheon, Korea.
Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Am J Cardiol. 2017 Jun 15;119(12):2049-2055. doi: 10.1016/j.amjcard.2017.03.038. Epub 2017 Mar 29.
Bicuspid aortic valve (BAV) disease has a male predominance of approximately 3:1 and shows diverse presentations about aortic valve dysfunction. This study aimed to find independent determinants for significant aortic stenosis (AS) or significant aortic regurgitation (AR) in adults with BAV. We retrospectively investigated the medical records of 1,073 subjects (773 men, mean age 55 ± 14 years) who were first diagnosed with BAV disease by transthoracic echocardiography. We excluded 52 subjects with both significant AS and significant AR. Of the remaining 1,021 subjects, 418 (41%) presented with significant AS, 249 (24%) showed significant AR, and the rest of the subjects were grouped into a normal functioning BAV (n = 354, 35%). BAV morphology was classified into the following 4 types according to position and pattern of raphe and cusps: (1) fusion of the right and left coronary cusps (type 1), (2) fusion of the right and noncoronary cusps (type 2), (3) fusion of the left and noncoronary (type 3), and (4) no raphe (type 0). Patients with significant AS were older, more likely to be women than men, and had a higher prevalence of type 0 BAV. Patients with significant AR were younger and were more likely to be men. In multivariate logistic regression analysis, women, older age, and type 0 or type 3 BAV were associated with significant AS. In contrast, men, hypertension, and chronic kidney disease were correlated with significant AR. Significant valve dysfunction in adults with first diagnosed BAV was closely associated with age, gender, and BAV morphology.
二叶式主动脉瓣（BAV）疾病男性发病率约为女性的3倍，且表现出多种主动脉瓣功能障碍形式。本研究旨在寻找成年BAV患者发生严重主动脉瓣狭窄（AS）或严重主动脉瓣反流（AR）的独立决定因素。我们回顾性调查了1073例经胸超声心动图首次诊断为BAV疾病患者的病历（773例男性，平均年龄55±14岁）。我们排除了52例同时患有严重AS和严重AR的患者。在其余1021例患者中，418例（41%）表现为严重AS，249例（24%）表现为严重AR，其余患者归为功能正常的BAV组（n = 354，35%）。根据嵴和瓣叶的位置及形态，BAV形态分为以下4种类型：（1）左右冠状动脉瓣叶融合（1型），（2）右和无冠状动脉瓣叶融合（2型），（3）左和无冠状动脉瓣叶融合（3型），以及（4）无嵴（0型）。严重AS患者年龄较大，女性多于男性，且0型BAV患病率较高。严重AR患者年龄较轻，男性多于女性。在多因素logistic回归分析中，女性、年龄较大以及0型或3型BAV与严重AS相关。相比之下，男性、高血压和慢性肾脏病与严重AR相关。首次诊断为BAV的成年患者严重瓣膜功能障碍与年龄、性别和BAV形态密切相关。
