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Differences in aortic growth in the presence of aortic coarctation in a population of bicuspid aortic valve patients
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1University of Bristol - Bristol - United Kingdom of Great Britain & Northern Ireland
2Bristol Heart Institute - Bristol - United Kingdom of Great Britain & Northern Ireland
3University College London - London - United Kingdom of Great Britain & Northern Ireland
Despite known phenotypic variations in bicuspid aortic valve (BAV) aortopathy, and differences in aortic architecture in BAV patients with aortic coarctation (CoA), determinants of aortic growth are not fully known.
This study aimed to evaluate the effect of the presence of CoA on aortic growth in BAV patients. We hypothesised that i) patients with CoA would exhibit decreased aortic growth compared to those without, ii) patients with re-CoA and/or with valvular dysfunction would exhibit higher growth rate, and iii) patients with right-non-coronary (RN) fusion pattern would exhibit increased aortic growth compared to right-left (RL) and type 0 valve fusion.
We retrospectively identified n=521 patients with cardiac magnetic resonance (CMR) data and native BAV diagnosis. We then applied inclusion criteria (i.e. availability of at least two scans before aortic valve replacement) and exclusion criteria (i.e. poor quality CMR images, concomitant complex congenital heart diseases, connective tissue disorders and unrepaired CoA) to select patients for the aortic growth analysis. Indexed areas of the sinuses of Valsalva and ascending aorta were calculated from cine images (3-chamber and left ventricular outflow tract view, Figure 1A) in end-systole and end-diastole. Patients were classified based on dilation phenotype, presence of CoA, aortic valve function and BAV phenotype. Comparisons between groups were performed and linear regression was carried out to identify associations between risk factors and aortic growth.
We analysed n=146 patients with at least two CMR scans (39±16 years, 68% male). For each patient, scans were 3.7±1.8 years apart. We classified 63 BAV patients without dilation, 32 with ascending aorta dilation, 18 with root dilation, and 32 overall dilated. CoA patients showed decreased aortic root growth compared to patients without CoA (end-diastole: 0.05 vs 0.14 cm2/m*yr, p=0.03; end-systole: 0.05 vs 0.17 cm2/m*yr, p=0.005, Figure 1B) regardless of gender or age. Re-CoA, aortic stenosis, regurgitation and hypertension were not associated with aortic growth. RN fusion pattern of the aortic valve showed the highest aortic root growth in end-systole, whereas type 0 valve had the smallest growth (0.30 vs 0.10 vs 0.08 cm2/m*yr, p=0.03). Based on follow-up measurements, 4 patients would be at risk of dissection and possible candidates for surgery, with area >10 cm2/m and 48-50 mm diameter.
BAV patients are known to have lower threshold mandating surgical treatment in official guidelines, compared to patients with a tricuspid aortic valve. In our BAV population, presence of CoA was associated with lower rate of root dilation. Over this relatively short time window, cusp fusion morphotype also appeared to affect root growth, RN having the highest rate.
ESC 365 is supported by Bayer, Boehringer Ingelheim and Lilly Alliance, Bristol-Myers Squibb and Pfizer Alliance, Novartis Pharma AG and Vifor Pharma in the form of educational grants. The sponsors were not involved in the development of this platform and had no influence on its content.
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