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Does aortic valve morphology influence aortic stenosis progression and outcomes? A comparative study of bicuspid and tricuspid aortic valves
Session:
Sessão de Posters 33 - Cardiopatia congénita e hipertensão pulmonar: da evidência à ação
Speaker:
Leonor Moura
Congress:
CPC 2026
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
15. Valvular Heart Disease
Subtheme:
15.2 Valvular Heart Disease – Epidemiology, Prognosis, Outcome
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Maria Leonor Moura; Marta Catarina Almeida; Rafael Teixeira; Francisca Martins Nunes; Francisco Lemos de Sousa; Inês Arrobas Rodrigues; António Gonçalves; André Lobo; Marta Leite; Inês Neves; Rita Faria; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong> Bicuspid aortic valve (BAV) is a congenital heart defect associated with early valve dysfunction, most commonly aortic stenosis (AS). Factors related to AS progression rate and prognostic implications in these patients are still poorly understood.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>The aim of this study was to compare AS patients with BAV and tricuspid aortic valves (TAV), exploring AS progression rate, its predictors and impact on mortality.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Retrospective data of patients with native AS from a single center were collected. Patients with more than one transthoracic echocardiogram and preserved left ventricular ejection fraction were included. BAV patients were identified using confirmatory CT scans and were age and sex-matched to TAV controls in a 1:1 ratio. A mixed-effects non-linear model was used to assess potential biphasic progression of aortic peak velocity (APV). AS progression rate was calculated by a core model parameter and compared between patients with BAV and TAV. Linear regression was used to explore predictors of AS progression and Cox proportional hazards model to compare mortality between BAV and TAV patients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> 80 matched patient-pairs were included (age 54±11 years, 40% female). TAV patients had higher prevalence of hypertension (81% vs 41%, p<0.001), diabetes (39% vs 8%, p<0.001), dyslipidemia (71% vs 26%, p<0.001) and obesity (36% vs 10%, p<0.01). Differences in baseline APV between patients with BAV and TAV did not reach statistical significance (2.9±0.9 vs 2.7±1.0 m/s, p=0.05). Follow-up time was higher for patients with TAV (5.9±2.6 vs 4.6±2.8 years, p<0.01). AS progression rate was lower in BAV patients (0.02±0.04 vs 0.11±0.04 m/s per year, p<0.001). No comorbidities were significantly associated with AS progression. TAV patients had higher all-cause mortality (HR = 11.2, 95% CI 1.47-85.7, p=0.02). However, TAV was not an independent predictor of mortality in the multivariate analysis adjusted for comorbidities and AS progression rate.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>This study suggests that, although BAV is associated with earlier development of valve dysfunction, progression may be more gradual in BAV than TAV patients. The differences in progression rate were not attributable to initial disease severity, which emphasizes the need to focus on cardiovascular risk factor control in this population.</span></span></p>
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