Shen Mylène, Tastet Lionel, Capoulade Romain, Bédard Élisabeth, Arsenault Marie, Clavel Marie-Annick, Pibarot Philippe
Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Université Laval, Québec City, Québec, Canada.
CHU Nantes, CNRS, INSERM, l'institut du thorax, Université de Nantes, Nantes, France.
CJC Pediatr Congenit Heart Dis. 2022 Jul 7;1(4):184-192. doi: 10.1016/j.cjcpc.2022.06.004. eCollection 2022 Aug.
Bicuspid aortic valve (BAV) is associated with a faster progression of aortic stenosis (AS). Whether the determinants of AS progression are the same or different in patients with BAV vs tricuspid aortic valve (TAV) is unknown. The aim of this study was to identify the factors associated with the progression of AS in patients with BAV vs patients with TAV.
Patients with AS were prospectively recruited in the Metabolic Determinants of the Progression of Aortic Stenosis (PROGRESSA) study (ClinicalTrials.gov Identifier: NCT01679431). The haemodynamic progression rate of AS was assessed by the annualized progression rate of peak aortic jet velocity (V). Univariable and multivariable linear regression analyses were used to identify the factors associated with a faster progression of AS in patients with BAV vs patients with TAV.
There were 79 patients with BAV and 208 patients with TAV. The baseline severity of AS was similar between the 2 groups of patients as well as the annualized progression rate of AS. In patients with BAV, obesity (β = 0.25, = 0.04), diabetes (β = 0.26, = 0.02), and BAV with right-noncoronary cusp fusion (β = 0.29, = 0.01) were found to be independently associated with a faster progression of AS, whereas in patients with TAV, AS baseline severity (baseline V, β = 0.14, = 0.04) and chronic kidney disease (β = 0.16, = 0.02) were significantly associated with AS progression.
Factors associated with progression rate of AS are different in BAV and TAV. The main factors associated with a faster progression of AS appear to be obesity, diabetes, right-noncoronary cusp fusion in patients with BAV vs chronic kidney disease in patients with TAV.
二叶式主动脉瓣（BAV）与主动脉瓣狭窄（AS）的进展加快相关。在BAV患者与三叶式主动脉瓣（TAV）患者中，AS进展的决定因素是否相同尚不清楚。本研究的目的是确定BAV患者与TAV患者中与AS进展相关的因素。
在主动脉瓣狭窄进展的代谢决定因素（PROGRESSA）研究（ClinicalTrials.gov标识符：NCT01679431）中前瞻性招募AS患者。通过主动脉峰值射流速度（V）的年化进展率评估AS的血流动力学进展率。采用单变量和多变量线性回归分析来确定BAV患者与TAV患者中与AS更快进展相关的因素。
有79例BAV患者和208例TAV患者。两组患者的AS基线严重程度以及AS的年化进展率相似。在BAV患者中，发现肥胖（β = 0.25，P = 0.04）、糖尿病（β = 0.26，P = 0.02）和右无冠瓣融合的BAV（β = 0.29，P = 0.01）与AS更快进展独立相关，而在TAV患者中，AS基线严重程度（基线V，β = 0.14，P = 0.04）和慢性肾脏病（β = 0.16，P = 0.02）与AS进展显著相关。
BAV和TAV中与AS进展率相关的因素不同。与AS更快进展相关的主要因素在BAV患者中似乎是肥胖、糖尿病、右无冠瓣融合，而在TAV患者中是慢性肾脏病。
