Patterns of ascending aortic dilatation and predictors of surgical replacement of the aorta: A comparison of bicuspid and tricuspid aortic valve patients over eight years of follow-up

Salvatore Pasta, Valentina Agnese, Hector I. Michelena, Michele Pilato, Diego Bellavia, Giuseppe Raffa, Salvatore Pasta, Scipione Carerj, Giuseppe Maria Romano, Chiara Minà, Valentina Agnese, Scipione Carerj, Hector I. Michelena, Francesco Clemenza, Joseph F. Maalouf, Concetta Zito, Thomas A. Foley, Chiara Mina', Giorgia Maria Giovanna Raffa

Risultato della ricerca: Article

Abstract

Background: Predictors of thoracic aorta growth and early cardiac surgery in patients with bicuspid aortic valve are undefined. Our aim was to identify predictors of ascending aorta dilatation and cardiac surgery in patients with bicuspid aortic valve (BAV).Methods: Forty-one patients with BAV were compared with 165 patients with tricuspid aortic valve (TAV). All patients had LV EF > 50%, normal LV dimensions, and similar degree of aortic root or ascending aorta dilatation at enrollment. Patients with more than mild aortic stenosis or regurgitation were excluded. A CT-scan was available on 76% of the population, and an echocardiogram was repeated every year for a median time of 4 years (range: 2 to 8 years). Patterns of aortic expansion in BAV and TAV groups were analyzed by a mixed-effects longitudinal linear model. In the time-to-event analysis, the primary end point was elective or emergent surgery for aorta replacement.Results: BAV patients were younger, while the TAV group had greater LV wall thickness, arterial hypertension, and dyslipidemia than BAV patients. Growth rate was 0.46 +/- 0.04 mm/year, similar in BAV and TAV groups (p = 0.70). Predictors of cardiac surgery were aorta dimensions at baseline (HR 1.23, p = 0.01), severe aortic regurgitation developed during follow-up (HR 3.49, p 0.04), family history of aortic aneurysm (HR 4.16, p 1.73), and history of STEMI (HR 3.64, p < 0.001).Conclusions: Classic baseline risk factors were more commonly observed in TAV aortopathy compared with BAV aortopathy. However, it is reassuring that, though diagnosed with aneurysm on average 10 years earlier and in the absence of arterial hypertension, BAV patients had a relatively low growth rate, similar to patients with a tricuspid valve. Irrespective of aortic valve morphology, patients with a family history of aortic aneurysm, history of coronary artery disease, and those who developed severe aortic regurgitation at follow-up, had the highest chances of being referred for surgery.
Lingua originaleEnglish
pagine (da-a)31-39
Numero di pagine9
RivistaJournal of Molecular and Cellular Cardiology
Volume135
Stato di pubblicazionePublished - 2019

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Tricuspid Valve
Aorta
Dilatation
Aortic Valve
Aortic Valve Insufficiency
Thoracic Surgery
Aortic Aneurysm
Bicuspid Aortic Valve
Growth
Hypertension
Aortic Valve Stenosis
Dyslipidemias
Thoracic Aorta
Aneurysm
Coronary Artery Disease
Linear Models

All Science Journal Classification (ASJC) codes

  • Molecular Biology
  • Cardiology and Cardiovascular Medicine

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Patterns of ascending aortic dilatation and predictors of surgical replacement of the aorta: A comparison of bicuspid and tricuspid aortic valve patients over eight years of follow-up. / Pasta, Salvatore; Agnese, Valentina; Michelena, Hector I.; Pilato, Michele; Bellavia, Diego; Raffa, Giuseppe; Pasta, Salvatore; Carerj, Scipione; Romano, Giuseppe Maria; Minà, Chiara; Agnese, Valentina; Carerj, Scipione; Michelena, Hector I.; Clemenza, Francesco; Maalouf, Joseph F.; Zito, Concetta; Foley, Thomas A.; Mina', Chiara; Raffa, Giorgia Maria Giovanna.

In: Journal of Molecular and Cellular Cardiology, Vol. 135, 2019, pag. 31-39.

Risultato della ricerca: Article

Pasta, S, Agnese, V, Michelena, HI, Pilato, M, Bellavia, D, Raffa, G, Pasta, S, Carerj, S, Romano, GM, Minà, C, Agnese, V, Carerj, S, Michelena, HI, Clemenza, F, Maalouf, JF, Zito, C, Foley, TA, Mina', C & Raffa, GMG 2019, 'Patterns of ascending aortic dilatation and predictors of surgical replacement of the aorta: A comparison of bicuspid and tricuspid aortic valve patients over eight years of follow-up', Journal of Molecular and Cellular Cardiology, vol. 135, pagg. 31-39.
Pasta, Salvatore ; Agnese, Valentina ; Michelena, Hector I. ; Pilato, Michele ; Bellavia, Diego ; Raffa, Giuseppe ; Pasta, Salvatore ; Carerj, Scipione ; Romano, Giuseppe Maria ; Minà, Chiara ; Agnese, Valentina ; Carerj, Scipione ; Michelena, Hector I. ; Clemenza, Francesco ; Maalouf, Joseph F. ; Zito, Concetta ; Foley, Thomas A. ; Mina', Chiara ; Raffa, Giorgia Maria Giovanna. / Patterns of ascending aortic dilatation and predictors of surgical replacement of the aorta: A comparison of bicuspid and tricuspid aortic valve patients over eight years of follow-up. In: Journal of Molecular and Cellular Cardiology. 2019 ; Vol. 135. pagg. 31-39.
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title = "Patterns of ascending aortic dilatation and predictors of surgical replacement of the aorta: A comparison of bicuspid and tricuspid aortic valve patients over eight years of follow-up",
abstract = "Background: Predictors of thoracic aorta growth and early cardiac surgery in patients with bicuspid aortic valve are undefined. Our aim was to identify predictors of ascending aorta dilatation and cardiac surgery in patients with bicuspid aortic valve (BAV).Methods: Forty-one patients with BAV were compared with 165 patients with tricuspid aortic valve (TAV). All patients had LV EF > 50{\%}, normal LV dimensions, and similar degree of aortic root or ascending aorta dilatation at enrollment. Patients with more than mild aortic stenosis or regurgitation were excluded. A CT-scan was available on 76{\%} of the population, and an echocardiogram was repeated every year for a median time of 4 years (range: 2 to 8 years). Patterns of aortic expansion in BAV and TAV groups were analyzed by a mixed-effects longitudinal linear model. In the time-to-event analysis, the primary end point was elective or emergent surgery for aorta replacement.Results: BAV patients were younger, while the TAV group had greater LV wall thickness, arterial hypertension, and dyslipidemia than BAV patients. Growth rate was 0.46 +/- 0.04 mm/year, similar in BAV and TAV groups (p = 0.70). Predictors of cardiac surgery were aorta dimensions at baseline (HR 1.23, p = 0.01), severe aortic regurgitation developed during follow-up (HR 3.49, p 0.04), family history of aortic aneurysm (HR 4.16, p 1.73), and history of STEMI (HR 3.64, p < 0.001).Conclusions: Classic baseline risk factors were more commonly observed in TAV aortopathy compared with BAV aortopathy. However, it is reassuring that, though diagnosed with aneurysm on average 10 years earlier and in the absence of arterial hypertension, BAV patients had a relatively low growth rate, similar to patients with a tricuspid valve. Irrespective of aortic valve morphology, patients with a family history of aortic aneurysm, history of coronary artery disease, and those who developed severe aortic regurgitation at follow-up, had the highest chances of being referred for surgery.",
keywords = "Aneurysm, Bicuspid aortic valve, Echocardiography, Repeated measures, Thoracic aorta",
author = "Salvatore Pasta and Valentina Agnese and Michelena, {Hector I.} and Michele Pilato and Diego Bellavia and Giuseppe Raffa and Salvatore Pasta and Scipione Carerj and Romano, {Giuseppe Maria} and Chiara Min{\`a} and Valentina Agnese and Scipione Carerj and Michelena, {Hector I.} and Francesco Clemenza and Maalouf, {Joseph F.} and Concetta Zito and Foley, {Thomas A.} and Chiara Mina' and Raffa, {Giorgia Maria Giovanna}",
year = "2019",
language = "English",
volume = "135",
pages = "31--39",
journal = "Journal of Molecular and Cellular Cardiology",
issn = "0022-2828",
publisher = "Academic Press Inc.",

}

TY - JOUR

T1 - Patterns of ascending aortic dilatation and predictors of surgical replacement of the aorta: A comparison of bicuspid and tricuspid aortic valve patients over eight years of follow-up

AU - Pasta, Salvatore

AU - Agnese, Valentina

AU - Michelena, Hector I.

AU - Pilato, Michele

AU - Bellavia, Diego

AU - Raffa, Giuseppe

AU - Pasta, Salvatore

AU - Carerj, Scipione

AU - Romano, Giuseppe Maria

AU - Minà, Chiara

AU - Agnese, Valentina

AU - Carerj, Scipione

AU - Michelena, Hector I.

AU - Clemenza, Francesco

AU - Maalouf, Joseph F.

AU - Zito, Concetta

AU - Foley, Thomas A.

AU - Mina', Chiara

AU - Raffa, Giorgia Maria Giovanna

PY - 2019

Y1 - 2019

N2 - Background: Predictors of thoracic aorta growth and early cardiac surgery in patients with bicuspid aortic valve are undefined. Our aim was to identify predictors of ascending aorta dilatation and cardiac surgery in patients with bicuspid aortic valve (BAV).Methods: Forty-one patients with BAV were compared with 165 patients with tricuspid aortic valve (TAV). All patients had LV EF > 50%, normal LV dimensions, and similar degree of aortic root or ascending aorta dilatation at enrollment. Patients with more than mild aortic stenosis or regurgitation were excluded. A CT-scan was available on 76% of the population, and an echocardiogram was repeated every year for a median time of 4 years (range: 2 to 8 years). Patterns of aortic expansion in BAV and TAV groups were analyzed by a mixed-effects longitudinal linear model. In the time-to-event analysis, the primary end point was elective or emergent surgery for aorta replacement.Results: BAV patients were younger, while the TAV group had greater LV wall thickness, arterial hypertension, and dyslipidemia than BAV patients. Growth rate was 0.46 +/- 0.04 mm/year, similar in BAV and TAV groups (p = 0.70). Predictors of cardiac surgery were aorta dimensions at baseline (HR 1.23, p = 0.01), severe aortic regurgitation developed during follow-up (HR 3.49, p 0.04), family history of aortic aneurysm (HR 4.16, p 1.73), and history of STEMI (HR 3.64, p < 0.001).Conclusions: Classic baseline risk factors were more commonly observed in TAV aortopathy compared with BAV aortopathy. However, it is reassuring that, though diagnosed with aneurysm on average 10 years earlier and in the absence of arterial hypertension, BAV patients had a relatively low growth rate, similar to patients with a tricuspid valve. Irrespective of aortic valve morphology, patients with a family history of aortic aneurysm, history of coronary artery disease, and those who developed severe aortic regurgitation at follow-up, had the highest chances of being referred for surgery.

AB - Background: Predictors of thoracic aorta growth and early cardiac surgery in patients with bicuspid aortic valve are undefined. Our aim was to identify predictors of ascending aorta dilatation and cardiac surgery in patients with bicuspid aortic valve (BAV).Methods: Forty-one patients with BAV were compared with 165 patients with tricuspid aortic valve (TAV). All patients had LV EF > 50%, normal LV dimensions, and similar degree of aortic root or ascending aorta dilatation at enrollment. Patients with more than mild aortic stenosis or regurgitation were excluded. A CT-scan was available on 76% of the population, and an echocardiogram was repeated every year for a median time of 4 years (range: 2 to 8 years). Patterns of aortic expansion in BAV and TAV groups were analyzed by a mixed-effects longitudinal linear model. In the time-to-event analysis, the primary end point was elective or emergent surgery for aorta replacement.Results: BAV patients were younger, while the TAV group had greater LV wall thickness, arterial hypertension, and dyslipidemia than BAV patients. Growth rate was 0.46 +/- 0.04 mm/year, similar in BAV and TAV groups (p = 0.70). Predictors of cardiac surgery were aorta dimensions at baseline (HR 1.23, p = 0.01), severe aortic regurgitation developed during follow-up (HR 3.49, p 0.04), family history of aortic aneurysm (HR 4.16, p 1.73), and history of STEMI (HR 3.64, p < 0.001).Conclusions: Classic baseline risk factors were more commonly observed in TAV aortopathy compared with BAV aortopathy. However, it is reassuring that, though diagnosed with aneurysm on average 10 years earlier and in the absence of arterial hypertension, BAV patients had a relatively low growth rate, similar to patients with a tricuspid valve. Irrespective of aortic valve morphology, patients with a family history of aortic aneurysm, history of coronary artery disease, and those who developed severe aortic regurgitation at follow-up, had the highest chances of being referred for surgery.

KW - Aneurysm

KW - Bicuspid aortic valve

KW - Echocardiography

KW - Repeated measures

KW - Thoracic aorta

UR - http://hdl.handle.net/10447/376172

UR - http://www.elsevier.com/locate/yjmcc

M3 - Article

VL - 135

SP - 31

EP - 39

JO - Journal of Molecular and Cellular Cardiology

JF - Journal of Molecular and Cellular Cardiology

SN - 0022-2828

ER -