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Distribution Patterns of Valvular and Vascular Complications in Bicuspid Aortic Valve
Yongshi Wang1,2, Boting Wu3, Jun Li1
1Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University.
Insights
Bicuspid aortic valve (BAV) affects many Chinese patients, with prevalence varying by age and sex. Pure aortic regurgitation is more common in younger males, while stenosis and dilatation increase with age.
Area of Science:
- Cardiology
- Genetics
- Public Health
Background:
- Bicuspid aortic valve (BAV) is a common congenital heart defect associated with significant risks of aortic valve dysfunction and vascular complications.
- The prevalence and specific clinical characteristics of BAV in the Chinese population remain underexplored.
- Understanding these factors is crucial for effective risk stratification and management.
Purpose of the Study:
- To determine the prevalence and clinical features of BAV in a large Chinese cohort.
- To investigate the associations between BAV phenotypes, demographic factors, and aortic complications.
- To elucidate age- and sex-specific patterns of BAV-related cardiovascular issues.
Main Methods:
- Retrospective analysis of 3,673 BAV patients identified from 325,910 transthoracic echocardiography recipients between January 2011 and December 2015.
- Assessment of aortic valve dysfunction (stenosis, regurgitation, mixed), ascending aortic dilatation, and aortic root dilatation.
- Statistical analysis to evaluate associations with age, gender, and specific BAV cusp fusion types.
Main Results:
- BAV was identified in 3,673 patients (1.1% prevalence), with a 69.1% male predominance.
- Overt aortic valve dysfunction occurred in 58.4%, ascending aortic dilatation in 52.5%, and aortic root dilatation in 19.2%.
- Pure aortic stenosis and mixed dysfunction prevalence increased with age, while pure aortic regurgitation decreased.
- Males had higher rates of pure aortic regurgitation and mixed dysfunction but lower rates of pure aortic stenosis.
- Aortic root dilatation was linked to male gender, pure aortic regurgitation, and right-left cusp fusion.
- Ascending aortic dilatation was associated with older age, pure aortic stenosis, and mixed dysfunction.
Conclusions:
- BAV prevalence in this Chinese cohort is significant, with distinct age and sex-related clinical manifestations.
- Aortic stenosis and ascending aortic dilatation show age-related escalation, whereas aortic regurgitation is more prevalent in younger BAV patients.
- Aortic root dilatation is associated with a specific phenotype of male BAV patients with pure aortic regurgitation and RL cusp fusion, highlighting a distinct BAV subgroup.
Abstract:
For its high occurrence and elevated risks for aortic valve dysfunction and vascular complications, bicuspid aortic valve (BAV) represents a great health challenge. However, the prevalence and clinical features of BAV in the Chinese population are inadequately illustrated.From January 2011 to December 2015, 3,673 BAV patients with 69.1% male predominance were identified among 325,910 recipients of transthoracic echocardiography in our institution, demonstrating 58.4% overt aortic valve dysfunction, 52.5% ascending aortic dilatation, and 19.2% aortic root dilatation. The prevalence of pure aortic stenosis and mixed aortic valve dysfunction rose strikingly with age (both P < 0.0001), while pure aortic regurgitation showed significant decrease with age (P < 0.0001). Males showed elevated prevalence of pure aortic regurgitation (OR 3.16, 95% CI 2.55-3.91, P < 0.0001) and mixed aortic valve dysfunction than females (OR 1.63, 95% CI 1.23-2.17, P = 0.0008), but lower prevalence of pure aortic stenosis (OR 0.51, 95% CI 0.43-0.60, P < 0.0001). Aortic root dilatation was associated with male gender (OR 5.02, 95% CI 3.74-6.74, P < 0.0001), pure aortic regurgitation (OR 2.61, 95% CI 2.15-3.17, P < 0.0001), and right-left (RL) cusp fusion type (OR 1.98, 95% CI 1.64-2.40, P < 0.0001). Ascending aortic dilatation was associated with an elder age (OR 1.04, 95% CI 1.04-1.05, P < 0.0001), pure aortic stenosis (OR 1.37, 95% CI 1.16-1.61 P = 0.0002), and mixed aortic valve dysfunction (OR 2.51, 95% CI 1.89-3.33, P < 0.0001).Bicuspid aortic stenosis and ascending aortic dilatation demonstrate a similar pattern of age escalation, while aortic regurgitation is more prevalent in younger BAV patients. Aortic root dilatation intervenes closely with a unique phenotypic subgroup of male BAV patients with pure aortic regurgitation and RL fusion type.
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