Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore. Electronic address: https://twitter.com/elisabettasabet.
Department of Medicine, National University Health System, Singapore.
Heart Lung Circ. 2022 Apr;31(4):469-479. doi: 10.1016/j.hlc.2021.10.023. Epub 2021 Nov 26.
There are differences in bicuspid aortic valve (BAV) characteristics between Asian and European populations, but little is known about the inter-ethnic differences in bicuspid valve function and aortic root dimensions within the diverse Asian population.
From 1992-2017, 562 patients with index echocardiographic diagnosis of BAV in a tertiary health care institution in Singapore were analysed according to their ethnic groups: Chinese, Malay, Indian, and Eurasian. Study outcomes included BAV complications (infective endocarditis, aortic dissection) and clinical outcomes (aortic valve surgery, aortic root surgery, all-cause mortality). Total events were defined as composite outcome of all BAV complications and outcomes. Aortic dimensions and aortic dilatation rates were also studied.
There were 379 (67.5%) Chinese, 79 (14.0%) Malay, 73 (13.0%) Indian, and 31 (5.5%) Eurasian patients. Type 1 BAV (58.5%) was the most prevalent BAV morphology, with moderate-to-severe aortic stenosis (AS) (36.8%) being the most common complication in the overall population. There was a higher prevalence of type 0 BAV in Chinese and Indian groups, and type 1 BAV with fusion of left-right coronary cusp in Eurasian and Malay groups (p=0.082). There was no difference in significant AS among groups. The highest prevalence of moderate-to-severe aortic regurgitation was observed amongst the Eurasian group, followed by Chinese, Indian, and Malay groups (p=0.033). The Chinese group had the largest mean indexed diameters of the aortic root. Multivariable linear regression demonstrated that only the Chinese had significantly larger indexed diameters in the aortic annulus, sinotubular junction (STJ), and ascending aorta (AA), relative to the Eurasian group, after adjusting for age, sex, smoking, hypertension, hyperlipidaemia, diabetes, and aortic regurgitation. On follow-up echocardiography, there was a trend towards the highest dilatation rates of sinus of Valsalva and STJ amongst Indian, and AA amongst Malay groups. Kaplan-Meier curves showed the highest incidence of total events amongst Chinese, followed by Malay, Indian and Eurasian (log-rank=9.691; p=0.021) patients.
There were differences in BAV morphology, valve dysfunction, aortopathy, and prognosis within the Asian population. Chinese patients had one of the highest prevalence of significant aortic regurgitation, with the largest aortic dimensions and worst outcomes compared with other Asian ethnicities. Closer surveillance is warranted in BAV patients within the Asian population.
亚洲人和欧洲人之间的二叶式主动脉瓣（BAV）特征存在差异，但对于亚洲多样化人群中二叶瓣功能和主动脉根部尺寸的种族间差异知之甚少。
1992 年至 2017 年，对新加坡一家三级医疗机构索引超声心动图诊断为 BAV 的 562 例患者进行分析，根据其种族分为：华人、马来人、印度人和欧亚人。研究结果包括 BAV 并发症（感染性心内膜炎、主动脉夹层）和临床结局（主动脉瓣手术、主动脉根部手术、全因死亡率）。总事件定义为所有 BAV 并发症和结局的复合结果。还研究了主动脉尺寸和主动脉扩张率。
有 379 例（67.5%）为华人、79 例（14.0%）马来人、73 例（13.0%）印度人和 31 例（5.5%）欧亚人。1 型 BAV（58.5%）是最常见的 BAV 形态，中重度主动脉瓣狭窄（AS）（36.8%）是整体人群中最常见的并发症。华人组和印度组中 0 型 BAV 的发生率较高，而欧亚组和马来组中 1 型 BAV 伴左右冠状动脉瓣融合（p=0.082）。各组间严重 AS 发生率无差异。中重度主动脉瓣反流发生率以欧亚组最高，其次为华人组、印度组和马来组（p=0.033）。华人组主动脉根部的平均指数直径最大。多变量线性回归显示，在调整年龄、性别、吸烟、高血压、高血脂、糖尿病和主动脉瓣反流后，仅华人组主动脉瓣环、窦管交界（STJ）和升主动脉（AA）的指数直径明显大于欧亚组。在后续的超声心动图检查中，印度组的窦瘤和 STJ 扩张率最高，马来组的 AA 扩张率最高。Kaplan-Meier 曲线显示华人组的总事件发生率最高，其次是马来人、印度人和欧亚人（对数秩=9.691；p=0.021）。
亚洲人群中二叶瓣形态、瓣膜功能障碍、主动脉病变和预后存在差异。与其他亚洲种族相比，华人患者中严重主动脉瓣反流的发生率最高，主动脉尺寸最大，预后最差。亚洲人群中需要对 BAV 患者进行更密切的监测。
