|
Title A Clinical and Echocardiographic Comparative Study of Patients with Asymptomatic Moderate and Severe Bicuspid and Tricuspid Aortic Valve Stenosis |
|
Type Free Paper Session 1 |
|
Theme ACC Asia & SCS 32nd Annual Scientific Meeting |
|
Topic Non-Invasive Cardiac Imaging, Echocardiography, Nuclear Cardiology / Adult Congenital Heart Disease / Cardiac Surgery |
|
Main Author Joe Jia-Liang Chua1 |
|
Presenting Author Joe Jia-Liang Chua1 |
|
Co-Author Ching-Hui Sia2 Benjamin Yong-Qiang Tan3 Nicholas Jinghao Ngiam3 Hui-Wen Sim2 Tiong-Cheng Yeo1 2 William Kok-Fai Kong1 2 Kian-Keong Poh1 2 |
|
Department / Institution / Country Yong Loo Lin School of Medicine / National University of Singapore / Singapore1 Department of Cardiology / National University Heart Centre / Singapore2 Department of Medicine / National University Health System / Singapore3 |
|
Objective(s) To guide the management of asymptomatic moderate and severe bicuspid (BAV) and tricuspid (TAV) aortic valve patients prior to aortic valve replacement (AVR), we aimed to describe and compare differences in clinical and echocardiographic parameters between the 2 groups. |
|
Material and Method We performed a retrospective cohort study in a tertiary academic centre. 554 consecutive cases of asymptomatic aortic stenosis (512 TAV, 42 BAV) were identified from our echocardiographic database from 7thSeptember 2011 to 31stDecember 2015. Demographics, symptoms, aortic stenosis and aortic dimension parameters, left ventricular geometry and systolic/diastolic function were analysed. The outcomes (time-to-event analysis) were admission for congestive cardiac failure (CCF), AVR, all-cause mortality, and a composite endpoint of AVR and all-cause mortality. |
|
Result(s) Patients with TAV, compared with BAV, were about 2 decades older (76.4 vs 53.6 years, p<0.001) and more likely to be female (58.6% vs 40.5%, p=0.023). TAV patients had a higher prevalence of hypertension (81.2% vs 54.8%, p<0.001), diabetes (42.8% vs 14.3%, p<0.001) and chronic kidney disease (20.2% vs 4.8%, p=0.014). TAV patients had less severe aortic valve disease (aortic valve index 0.7cm2/m2vs 0.6cm2/m2, p=0.005) and smaller aortic dimensions (p<0.001). TAV patients also had more diastolic dysfunction with a lower septal S′ (6 vs 13cm/s, p=0.001), higher septal E/e′ (19 vs 15cm/s, p=0.039), and larger left atrial diameters (42 vs 39mm, p=0.004). Left ventricular parameters and geometry were similar. On multivariate Cox regression for the composite of AVR and all-cause mortality, significant predictors included prior CCF (HR 1.86, 95% CI 1.09–3.15) and aortic sinus diameter (HR 1.02, 95% CI 1.002–1.04) but not aortic valve severity or morphology. |
|
Conclusion Asymptomatic moderate and severe aortic stenosis patients with BAV and TAV demonstrate different clinical and echocardiographic findings. Treatment of comorbidities and regular valve surveillance may be helpful. |