Aortic Stenosis Progression , Cardiac Damage, and Survival
Résumé
OBJECTIVES This study sought to compare aortic stenosis (AS) progression rates, AS-related cardiac damage (AS-CD) indicator incidence and determinants, and survival between patients with tricuspid aortic valve (TAV)-AS and those with bicuspid aortic valve (BAV)-AS. BACKGROUND Differences in AS progression and AS-CD between patients with BAV and patients with TAV are unknown. METHODS We retrospectively studied consecutive patients with baseline peak aortic valve velocity (peakV) >-2.5 m/s and left ventricular ejection fraction >-50%. Follow-up echocardiograms (n = 4,818) provided multiparametric AS progression rates and AS-CD. RESULTS The study included 330 BAV (age 54 +/- 14 years) and 581 patients with TAV (age 72 +/- 11 years). At last echocardiogram (median: 5.9 years; interquartile range: 3.9 to 8.5 years), BAV-AS exhibited similar peakV and mean pressure gradient (MPG) as TAV-AS, but larger calculated aortic valve area due to larger aortic annulus (p < 0.0001). Multiparametric progression rates were similar between BAV-AS and TAV-AS (all p >-0.08) and did not predict age-/sex adjusted survival (p >-0.45). Independent determinants of rapid progression were male sex and baseline AS severity for TAV (all p <0.024), and age, baseline AS severity, and cardiac risk factors (age interaction: p = 0.02) for BAV (all p <0.005). At 12 years, patients with TAV-AS had a higher incidence of AS-CD than BAV-AS patients (p < 0.0001), resulting in significantly worse survival compared to BAV-AS (p < 0.0001). AS-CD were independently determined by multiple factors (MPG, age, sex, comorbidities, cardiac function; all p <0.039), and BAV was independently protective of most AS-CD (all p <0.05). CONCLUSIONS In this cohort, TAV-AS and BAV-AS progression rates were similar. Rapid progression did not affect survival and was determined by cardiac risk factors for BAV-AS (particularly in patients with BAV <60 years of age) and unmodifiable factors for TAV-AS. AS-CD and mortality were significantly higher in TAV-AS. Independent determinants of AS-CD were multifactorial, and BAV morphology was AS-CD protective. Therefore, the totality of AS burden (cardiac damage) is clinically crucial for TAV-AS, whereas attention to modifiable risk factors may be preventive for BAV-AS. (J Am Coll Cardiol Img 2021;14:1113-26) (c) 2021 by the American College of Cardiology Foundation.