Marie-Ange Fleury, Lionel Tastet, Jérémy Bernard, Mylène Shen, Romain Capoulade, Kathia Abdoun, Élisabeth Bédard, Marie Arsenault, Philippe Chetaille, Jonathan Beaudoin, Mathieu Bernier, Erwan Salaun, Nancy Côté, Philippe Pibarot, Sébastien Hecht
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Doppler echocardiography was performed annually to assess AS severity and measure ascending aorta (AA) dimensions. Baseline and last follow-up visit measurements were used to assess the annualised change.</p><p><strong>Results: </strong>Median AA annualised change was larger in BAV versus TAV (0.33±0.65 mm/year vs 0.21±0.56 mm/year, p=0.04). In the whole cohort, BAV phenotype and higher low-density lipoprotein (LDL) levels were significantly associated with fast progression of AA dilation in univariate analysis (OR 1.80, 95% CI 1.08 to 2.98, p=0.02; 1.37, 95% CI 1.04 to 1.80, p=0.03, respectively). AA dilation rate did not vary according to the BAV subtype (p=0.142). Predictors of AA progression rate were different between valve phenotypes, with higher apolipoprotein B/apolipoprotein A-I ratio, higher baseline peak aortic jet velocity (V<sub>peak</sub>) and smaller baseline AA diameter in the TAV cohort (all p<0.05) versus absence of hypertension, higher LDL levels and smaller baseline AA diameter in the BAV cohort (all p<0.02). In men, higher baseline V<sub>peak</sub> and smaller baseline AA (p<0.001) were independently associated with increased annualised AA dilation, while in women, higher LDL levels (p=0.026) were independently associated with faster AA dilation.</p><p><strong>Conclusion: </strong>This study suggests that BAV is associated with faster dilation of the AA. Predictors of AA dilation are different between valve phenotype and sex, with higher LDL levels being associated with faster AA dilation in BAV.</p>","PeriodicalId":19505,"journal":{"name":"Open Heart","volume":"11 2","pages":""},"PeriodicalIF":2.8000,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11487820/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effect of aortic valve phenotype and sex on aorta dilation in patients with aortic stenosis.\",\"authors\":\"Marie-Ange Fleury, Lionel Tastet, Jérémy Bernard, Mylène Shen, Romain Capoulade, Kathia Abdoun, Élisabeth Bédard, Marie Arsenault, Philippe Chetaille, Jonathan Beaudoin, Mathieu Bernier, Erwan Salaun, Nancy Côté, Philippe Pibarot, Sébastien Hecht\",\"doi\":\"10.1136/openhrt-2024-002912\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Bicuspid aortic valve (BAV) is often associated with a concomitant aortopathy. However, few studies have evaluated the effect of the aortic valve (AV) phenotype on the rate of dilation of the aorta. This study aimed to compare the progression rate of aorta dimensions according to AV phenotype (BAV vs tricuspid AV (TAV)), fusion type and sex in patients with aortic stenosis (AS).</p><p><strong>Methods: </strong>310 patients with AS (224 TAV and 86 BAV) recruited in the Metabolic Determinants of the Progression of Aortic Stenosis study (PROGRESSA, NCT01679431) were included in this analysis. Doppler echocardiography was performed annually to assess AS severity and measure ascending aorta (AA) dimensions. Baseline and last follow-up visit measurements were used to assess the annualised change.</p><p><strong>Results: </strong>Median AA annualised change was larger in BAV versus TAV (0.33±0.65 mm/year vs 0.21±0.56 mm/year, p=0.04). In the whole cohort, BAV phenotype and higher low-density lipoprotein (LDL) levels were significantly associated with fast progression of AA dilation in univariate analysis (OR 1.80, 95% CI 1.08 to 2.98, p=0.02; 1.37, 95% CI 1.04 to 1.80, p=0.03, respectively). AA dilation rate did not vary according to the BAV subtype (p=0.142). Predictors of AA progression rate were different between valve phenotypes, with higher apolipoprotein B/apolipoprotein A-I ratio, higher baseline peak aortic jet velocity (V<sub>peak</sub>) and smaller baseline AA diameter in the TAV cohort (all p<0.05) versus absence of hypertension, higher LDL levels and smaller baseline AA diameter in the BAV cohort (all p<0.02). In men, higher baseline V<sub>peak</sub> and smaller baseline AA (p<0.001) were independently associated with increased annualised AA dilation, while in women, higher LDL levels (p=0.026) were independently associated with faster AA dilation.</p><p><strong>Conclusion: </strong>This study suggests that BAV is associated with faster dilation of the AA. 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引用次数: 0
摘要
背景：主动脉瓣二尖瓣（BAV）通常伴有主动脉病变。然而，很少有研究评估主动脉瓣（AV）表型对主动脉扩张速度的影响。本研究旨在根据主动脉瓣表型（BAV 与三尖瓣 AV (TAV)）、融合类型和性别，比较主动脉狭窄（AS）患者主动脉尺寸的进展率。每年进行一次多普勒超声心动图检查，以评估主动脉瓣狭窄的严重程度并测量升主动脉（AA）的尺寸。基线测量值和最后一次随访测量值用于评估年化变化：结果：BAV与TAV相比，中位AA年化变化更大（0.33±0.65毫米/年 vs 0.21±0.56毫米/年，P=0.04）。在整个队列中，在单变量分析中，BAV 表型和较高的低密度脂蛋白（LDL）水平与 AA 扩张的快速进展显著相关（OR 分别为 1.80，95% CI 1.08 至 2.98，p=0.02；1.37，95% CI 1.04 至 1.80，p=0.03）。AA扩张率与BAV亚型无关（P=0.142）。不同瓣膜表型的 AA 进展率预测因素不同，TAV 队列的载脂蛋白 B/载脂蛋白 A-I 比率更高、基线主动脉喷射速度峰值（Vpeak）更高、基线 AA 直径更小（所有峰值和基线 AA 更小）（pConclusion）：这项研究表明，BAV 与 AA 的快速扩张有关。AA扩张的预测因素因瓣膜表型和性别而异，低密度脂蛋白水平越高，BAV的AA扩张越快。
Effect of aortic valve phenotype and sex on aorta dilation in patients with aortic stenosis.
Background: Bicuspid aortic valve (BAV) is often associated with a concomitant aortopathy. However, few studies have evaluated the effect of the aortic valve (AV) phenotype on the rate of dilation of the aorta. This study aimed to compare the progression rate of aorta dimensions according to AV phenotype (BAV vs tricuspid AV (TAV)), fusion type and sex in patients with aortic stenosis (AS).
Methods: 310 patients with AS (224 TAV and 86 BAV) recruited in the Metabolic Determinants of the Progression of Aortic Stenosis study (PROGRESSA, NCT01679431) were included in this analysis. Doppler echocardiography was performed annually to assess AS severity and measure ascending aorta (AA) dimensions. Baseline and last follow-up visit measurements were used to assess the annualised change.
Results: Median AA annualised change was larger in BAV versus TAV (0.33±0.65 mm/year vs 0.21±0.56 mm/year, p=0.04). In the whole cohort, BAV phenotype and higher low-density lipoprotein (LDL) levels were significantly associated with fast progression of AA dilation in univariate analysis (OR 1.80, 95% CI 1.08 to 2.98, p=0.02; 1.37, 95% CI 1.04 to 1.80, p=0.03, respectively). AA dilation rate did not vary according to the BAV subtype (p=0.142). Predictors of AA progression rate were different between valve phenotypes, with higher apolipoprotein B/apolipoprotein A-I ratio, higher baseline peak aortic jet velocity (Vpeak) and smaller baseline AA diameter in the TAV cohort (all p<0.05) versus absence of hypertension, higher LDL levels and smaller baseline AA diameter in the BAV cohort (all p<0.02). In men, higher baseline Vpeak and smaller baseline AA (p<0.001) were independently associated with increased annualised AA dilation, while in women, higher LDL levels (p=0.026) were independently associated with faster AA dilation.
Conclusion: This study suggests that BAV is associated with faster dilation of the AA. Predictors of AA dilation are different between valve phenotype and sex, with higher LDL levels being associated with faster AA dilation in BAV.
期刊介绍：
Open Heart is an online-only, open access cardiology journal that aims to be “open” in many ways: open access (free access for all readers), open peer review (unblinded peer review) and open data (data sharing is encouraged). The goal is to ensure maximum transparency and maximum impact on research progress and patient care. The journal is dedicated to publishing high quality, peer reviewed medical research in all disciplines and therapeutic areas of cardiovascular medicine. Research is published across all study phases and designs, from study protocols to phase I trials to meta-analyses, including small or specialist studies. Opinionated discussions on controversial topics are welcomed. Open Heart aims to operate a fast submission and review process with continuous publication online, to ensure timely, up-to-date research is available worldwide. The journal adheres to a rigorous and transparent peer review process, and all articles go through a statistical assessment to ensure robustness of the analyses. Open Heart is an official journal of the British Cardiovascular Society.
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