Risk Stratification in Bicuspid Aortic Valve Aortopathy: Emerging Evidence and Future Perspectives

Area of Science:

• Cardiology
• Vascular Surgery
• Radiology

Background:

• Bicuspid aortic valve aortopathy management traditionally uses dimensional parameters, which have limited predictive value for acute complications like aortic dissection.
• The disease presents heterogeneous clinical and natural histories, necessitating advanced risk stratification strategies.
• Current approaches inadequately capture the risk of aortic dissection and aneurysm progression.

Purpose of the Study:

• To review and summarize recent advancements in risk stratification for bicuspid aortic valve aortopathy.
• To highlight novel approaches beyond traditional dimensional criteria.
• To discuss critical aspects and ongoing debates in predicting disease progression and complications.

Main Methods:

• Review of current literature on bicuspid aortic valve aortopathy risk stratification.
• Analysis of phenotypic criteria, including identification of severe root phenotypes.
• Exploration of 4D-flow MRI metrics for flow derangement and circulating biomarkers for disease prediction.

Main Results:

• Dimensional criteria alone are insufficient for predicting aortic dissection risk.
• Phenotypic analysis identifies severe root phenotypes associated with higher progression and dissection risk.
• Novel metrics from 4D-flow MRI and circulating biomarkers show promise in risk stratification.

Conclusions:

• Risk stratification for bicuspid aortic valve aortopathy requires moving beyond simple dimensional measurements.
• Integrating phenotypic, hemodynamic, and biomarker data offers a more comprehensive approach to patient management.
• Further research is crucial to validate and implement these novel strategies for improved patient outcomes.