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Blood and Imaging Biomarkers in the Long-term Follow-up of Bicuspid Aortic Valve Patients
Zoë A Keuning1, Paul M Hendriks1, Anthonie L Duijnhouwer2
1Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
Insights
This study found sex differences in blood biomarkers for bicuspid aortic valve (BAV) patients. N-terminal pro B-type natriuretic peptide (NT-proBNP) and echocardiographic markers are key for predicting long-term outcomes.
Area of Science:
- Cardiology
- Congenital Heart Disease
- Biomarker Research
Background:
- Bicuspid aortic valve (BAV) is a prevalent congenital heart defect.
- BAV patients face risks of long-term complications like aortic stenosis and regurgitation.
Purpose of the Study:
- Investigate sex-based differences in blood and imaging biomarkers in BAV patients.
- Determine the long-term prognostic significance of these biomarkers.
Main Methods:
- Included 182 BAV patients from two prospective cohorts.
- Collected blood samples for RDW, creatinine, CRP, troponin T, NT-proBNP, TGF-β analysis.
- Performed echocardiography with speckle tracking; analyzed associations with survival using Cox regression.
Main Results:
- Observed sex differences in biomarker levels: higher CRP, NT-proBNP, RDW in women; higher creatinine, troponin T, TGF-β in men.
- NT-proBNP significantly associated with arrhythmia-free and intervention-free survival (HRs 1.94 and 2.06).
- Echocardiographic findings like increased LA size and LV mass index correlated with poorer survival outcomes.
Conclusions:
- Significant sex differences exist in blood biomarkers for BAV patients.
- NT-proBNP and diastolic left ventricular function are crucial prognostic indicators.
- These biomarkers can enhance clinical management and risk stratification for BAV.
Background:
Bicuspid aortic valve (BAV) is a common congenital heart defect. Patients with BAV are at risk for long-term complications such as valve stenosis and regurgitation. This study aimed to investigate sex differences in blood and imaging biomarkers and to describe the long-term prognostic value of blood and echocardiographic biomarkers.
Methods:
Patients were included from 2 prospective observational cohort studies; they underwent venous blood sampling and transthoracic echocardiography including speckle tracking. Analyzed blood biomarkers were red-cell distribution width (RDW), creatinine, C-reactive protein (CRP), troponin T, N-terminal pro B-type natriuretic peptide (NT-proBNP), and transforming growth factor-beta (TGF-β). Sex differences were analyzed at baseline. Associations between biomarkers and arrhythmia-free and intervention-free survival were determined by Cox regression, adjusted for age and sex.
Results:
A total of 182 patients with BAV were included: median age 34; interquartile range [IQR]: 23-46 years; 55.5% male. CRP, NT-proBNP, and RDW were higher in women, whereas creatinine, troponin T and TGF-β were higher among men. After a median follow-up time of 6.9 (IQR: 6.5-9.9) years, arrhythmia-free and intervention-free survival was, 81.0% and 73.1%, respectively. NT-proBNP was associated with both arrhythmia-free and intervention-free survival (hazard ratio [HR], 1.94, P = 0.005 and HR, 2.06, P = 0.002, respectively). On echocardiography higher left atrial (LA) size, left ventricular end-diastolic diameter (LVEDD), left ventricular (LV) mass index and E/e' ratio were associated with lower arrhythmia-free survival, whereas higher LA size, LV mass index, aortic valve peak velocity, and aortic regurgitation were associated with lower intervention-free survival.
Conclusions:
Differences were observed in blood biomarkers between men and women with BAV. Besides LV systolic parameters, diastolic LV function and NT-proBNP should have a more prominent role as prognostic markers in clinical care.
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