Aortic Cross-Sectional Area/Height Ratio and Outcomes in Patients With Bicuspid Aortic Valve and a Dilated Ascending Aorta

BACKGROUND:

In patients with bicuspid aortic valve and dilated proximal ascending aorta, we sought to assess (1) factors associated with increased longer-term cardiovascular mortality and (2) incremental prognostic use of indexing aortic root to patient height.

METHODS AND RESULTS:

We studied 969 consecutive bicuspid aortic valve patients (50±13 years; 87% men) with proximal aorta ≥4 cm, who also had a gated contrast-enhanced thoracic computed tomography or magnetic resonance angiography. A ratio of ascending aorticarea/height was calculated on tomography, and ≥10 cm2/m was considered abnormal, as previously reported. Society of Thoracic Surgeons score and cardiovascular death were recorded. Greater than or equal to III+ aortic regurgitation and severe aortic stenosis were seen in 37% and 10%, respectively. Society of Thoracic Surgeons score and right ventricular systolic pressure were 2±3 and 15±16 mm Hg, respectively. Abnormal ascending aortic area/height ratio was noted in 33%; 44% underwent ascending aortic surgery at 34 days. At 10.8 years (interquartile range, 9.6-12.3), 82 (9%) died (0.4% in-hospital postoperative mortality). On multivariable Cox survival analysis, ascendingaortic area/height ratio (hazard ratio, 2; 95% confidence interval, 1.20-3.35) was associated with cardiovascular death, whereas aorticsurgery (hazard ratio, 0.46; confidence interval, 0.26-0.80) was associated with improved survival (both P<0.01). Of the 405 patients with ascending aortic diameter of 4.5 to 5.5 cm, 64% had an abnormal ascending aortic area/height ratio, and 70% deaths occurred in patientswith an abnormal ratio.

CONCLUSIONS:

In bicuspid aortic valve patients with dilated proximal ascending aortaascending aortic area/height ratio was independently associated with cardiovascular death.

PMID: 28592593

Posted in Computed Tomography and tagged , , , , .

One Comment

  1. EDITORIAL COMMENT:
    Indexed Aortic Area in Bicuspid Valve Disease: An Important Step Toward a More Personalized Approach to Risk Prediction and Clinical Decision Making
    Stephanie L. Sellers, Darra T. Murphy, and Jonathon A. Leipsic
    [link]

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