Department of Cardiology, National University Heart Centre Singapore, Singapore, Singapore.
Department of Medicine, National University Health System, Singapore, Singapore.
Am J Cardiol. 2021 Dec 15;161:76-83. doi: 10.1016/j.amjcard.2021.08.050. Epub 2021 Oct 6.
Studies on the impact of aortic valve anatomy (bicuspid aortic valve [BAV] or tricuspid aortic valve [TAV]) on the progression of moderate aortic stenosis (AS) and ascending aorta (AA) dilatation and its prognostic implications are limited. From 1991 to 2016, 288 asymptomatic patients with moderate AS detected during index echocardiography with at least 1 year of echocardiographic follow-up were retrospectively studied. Baseline clinical and echocardiographic characteristics were compared between patients with BAV (n = 80) and patients with TAV (n = 208). Co-primary outcomes were 1-year hemodynamic and anatomic progression of AS and AA dilatation. Secondary end points were the incidence of AA rapid progressors, all-cause mortality, aortic valve replacement, and congestive heart failure. Determinants of AS progression, AA diameters, AA dilatation, and prognostic outcomes were evaluated. Similar 1-year progression of the aortic valve peak velocity, V (9 ± 18 vs 9 ± 23 cm/s), mean gradient (1.5 ± 2.3 vs 1.3 ± 3.2 mm Hg), and aortic valve area (AVA) (-0.04 ± 0.09 vs -0.05 ± 0.10 cm) were noted for BAV and TAV groups, respectively. One-year progressions of AA were similar at Valsalva (0.11 ± 0.88 vs 0.14 ± 1.10 mm) and tubular levels (0.12 ± 0.68 vs 0.30 ± 1.51 mm) in BAV and TAV groups, respectively. A trend toward increased rapid AA progression in patients with BAV (31.3%) was observed compared with patients with TAV (14.8%, p = 0.099). BAV was associated with progression of V (β = 0.17, p = 0.036), the dimensionless index (β = -0.17, p = 0.008), and AVA (β = -0.14, p = 0.048), but not mean gradient after adjusting for age, baseline severity indexes, gender, hypertension, diabetes, and body surface area. Although BAV was a determinant of larger baseline AA diameter, there was no significant association between BAV and AA rapid progressors. Adjusted Kaplan-Meier curves demonstrated no differences in congestive heart failure, aortic valve replacement, or mortality between valve morphology. In conclusion, there was a similar 1-year disease progression in terms of AVA, V, mean gradient, and AA diameters between patients with BAV and patients with TAV. BAV was associated with a significant increase in V, dimensionless index, and AVA after adjusting for important confounders. Close and prolonged follow-up is warranted in both groups of patients.
研究主动脉瓣解剖结构（二叶式主动脉瓣[BAV]或三叶式主动脉瓣[TAV]）对中度主动脉瓣狭窄（AS）和升主动脉（AA）扩张进展的影响及其预后意义有限。1991 年至 2016 年，回顾性研究了 288 例在指数超声心动图中检测到的无症状中度 AS 患者，这些患者至少有 1 年的超声心动图随访。比较了 BAV（n=80）和 TAV（n=208）患者之间的基线临床和超声心动图特征。主要终点是 1 年的 AS 和 AA 扩张的血液动力学和解剖学进展。次要终点是 AA 快速进展者的发生率、全因死亡率、主动脉瓣置换和充血性心力衰竭。评估了 AS 进展、AA 直径、AA 扩张和预后结局的决定因素。BAV 和 TAV 组的主动脉瓣峰值速度 V（9±18 比 9±23cm/s）、平均梯度（1.5±2.3 比 1.3±3.2mmHg）和主动脉瓣面积（AVA）（-0.04±0.09 比-0.05±0.10cm）在 1 年内均有相似的进展。BAV 和 TAV 组在 Valsalva（0.11±0.88 比 0.14±1.10mm）和管状水平（0.12±0.68 比 0.30±1.51mm）的 AA 进展相似。与 TAV 患者（14.8%，p=0.099）相比，BAV 患者（31.3%）AA 快速进展的趋势更高。BAV 与 V（β=0.17，p=0.036）、无量纲指数（β=-0.17，p=0.008）和 AVA（β=-0.14，p=0.048）的进展相关，但与年龄、基线严重程度指数、性别、高血压、糖尿病和体表面积调整后的平均梯度无关。尽管 BAV 是基线 AA 直径较大的决定因素，但 BAV 与 AA 快速进展者之间无明显关联。调整后的 Kaplan-Meier 曲线显示，瓣膜形态之间充血性心力衰竭、主动脉瓣置换或死亡率无差异。结论：BAV 和 TAV 患者的 1 年 AVA、V、平均梯度和 AA 直径的疾病进展相似。BAV 与调整重要混杂因素后的 V、无量纲指数和 AVA 显著增加相关。两组患者均需要密切和长期随访。
Eur Heart J Cardiovasc Imaging. 2018-7-1
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