Left ventricular remodelling in bicuspid aortic valve disease

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Valvular Heart Disease

Background:

• Bicuspid aortic valve (BAV) with significant aortic valve (AV) disease can lead to left ventricular (LV) pressure or volume overload.
• Characterizing LV geometric patterns and mass is crucial for understanding pathophysiological adaptations in BAV patients.

Purpose of the Study:

• To investigate LV remodeling patterns in patients with BAV and significant AV disease.
• To determine the prognostic impact of LV remodeling based on the type of valvular dysfunction (AS, AR, or MAVD).

Main Methods:

• Analysis of a large international, multicenter BAV registry including 1345 patients.
• Classification of patients into isolated AS, isolated AR, or mixed aortic valve disease (MAVD) groups.
• Assessment of LV mass index and geometric patterns (normal, concentric remodeling, concentric hypertrophy, eccentric hypertrophy).
• Follow-up for event-free survival (AV repair/replacement and all-cause mortality) and all-cause mortality.

Main Results:

• LV hypertrophy was independently associated with adverse composite endpoints in isolated AS and AR, but not in MAVD.
• Specific LV geometric patterns (concentric remodeling, concentric hypertrophy, eccentric hypertrophy) were linked to poorer outcomes in isolated AS.
• Concentric and eccentric hypertrophy were independently associated with adverse outcomes in isolated AR.
• No significant association between LV remodeling and the composite endpoint was observed in the MAVD group.

Conclusions:

• LV hypertrophy and specific remodeling patterns are significant predictors of adverse outcomes in BAV patients with isolated AS or AR.
• The prognostic value of LV remodeling differs based on the predominant type of valvular dysfunction in BAV.
• Patients with MAVD and BAV may have different underlying pathophysiological mechanisms or compensatory strategies affecting LV remodeling outcomes.