Left ventricular remodelling in bicuspid aortic valve disease

Steele C. Butcher, Stephan M. Pio, William K.F. Kong, Gurpreet K. Singh, Arnold C.T. Ng, Rebecca Perry, Ching Hui Sia, Kian Keong Poh, Ana G. Almeida, Ariana González, Mylène Shen, Tiong Cheng Yeo, Miriam Shanks, Bogdan A. Popescu, Laura Galian Gay, Marcin Fijałkowski, Michael Liang, Edgar Tay, Nina Ajmone Marsan, Joseph SelvanayagamFausto Pinto, Jose L. Zamorano, Philippe Pibarot, Arturo Evangelista, Jeroen J. Bax, Victoria Delgado

Research output: Contribution to journalArticlepeer-review

13 Citations (Scopus)

Abstract

Aims Characterization of left ventricular (LV) geometric pattern and LV mass could provide an important insight into the pathophysiological adaptations of the LV to pressure and/or volume overload in patients with bicuspid aortic valve (BAV) and significant (>_moderate) aortic valve (AV) disease. This study aimed to characterize LV remodelling and its prognostic impact in patients with BAV according to the predominant type of valvular dysfunction. Methods In this international, multicentre BAV registry, 1345 patients [51.0 (37.0–63.0) years, 71% male] with significant AV and results disease were identified. Patients were classified as having isolated aortic stenosis (AS) (n = 669), isolated aortic regurgitation (AR) (n = 499) or mixed aortic valve disease (MAVD) (n = 177). LV hypertrophy was defined as a LV mass index >115 g/m2 in males and >95 g/m2 in females. LV geometric pattern was classified as (i) normal geometry: no LV hypertrophy, relative wall thickness (RWT) <_0.42, (ii) concentric remodelling: no LV hypertrophy, RWT >0.42, (iii) concentric hypertrophy: LV hypertrophy, RWT >0.42, and (iv) eccentric hypertrophy: LV hypertrophy, RWT <_0.42. Patients were followed-up for the endpoints of event-free survival (defined as a composite of AV repair/replacement and all-cause mortality) and all-cause mortality. Type of AV dysfunction was related to significant variations in LV remodelling. Higher LV mass index, i.e. LV hypertrophy, was independently associated with the composite endpoint for patients with isolated AS [hazard ratio (HR) 1.08 per 25 g/m2, 95% confidence interval (CI) 1.00–1.17, P = 0.046] and AR (HR 1.19 per 25 g/m2, 95% CI 1.11–1.29, P < 0.001), but not for those with MAVD. The presence of concentric remodelling, concentric hypertrophy and eccentric hypertrophy were independently related to the composite endpoint in patients with isolated AS (HR 1.54, 95% CI 1.06–2.23, P = 0.024; HR 1.68, 95% CI 1.17–2.42, P = 0.005; HR 1.59, 95% CI 1.03–2.45, P = 0.038, respectively), while concentric hypertrophy and eccentric hypertrophy were independently associated with the combined endpoint for those with isolated AR (HR 2.49, 95% CI 1.35–4.60, P = 0.004 and HR 3.05, 95% CI 1.71–5.45, P < 0.001, respectively). There was no independent association observed between LV remodelling and the combined endpoint for patients with MAVD. 

Conclusions: LV hypertrophy or remodelling were independently associated with the composite endpoint of AV repair/replacement and all-cause mortality for patients with isolated AS and isolated AR, although not for patients with MAVD.

Original languageEnglish
Pages (from-to)1669-1679
Number of pages11
JournalEuropean heart journal cardiovascular Imaging
Volume23
Issue number12
DOIs
Publication statusPublished - Dec 2022

Keywords

  • aortic regurgitation
  • aortic stenosis
  • bicuspid aortic valve
  • LV geometric pattern
  • LV mass index
  • LV remodelling
  • mixed aortic valve disease

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