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

Abstract

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 aortic area/height was calculated on tomography, and ≥10 cm 2 /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, ascending aortic area/height ratio (hazard ratio, 2; 95% confidence interval, 1.20–3.35) was associated with cardiovascular death, whereas aortic surgery (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 patients with an abnormal ratio. Conclusions— In bicuspid aortic valve patients with dilated proximal ascending aorta, ascending aortic area/height ratio was independently associated with cardiovascular death.

Determinants of aortic growth rate in patients with bicuspid aortic valve by cardiovascular magnetic resonance

“…Considering the indexed areas and the follow-up measurements from the current study, four patients in this population would be identified to be at risk of aortic dissection and requiring intervention, with area >10 cm 2 /m and 48–50 mm diameter 21 29. It should also be noted that our population is relatively young (average age 39 years overall) and while we cannot extrapolate information on growth rate beyond the time window that was studied, we cannot exclude further aortic dilation in these patients.…”

Thoracic aortic aneurysm: Optimal surveillance and treatment

“…If the maximal TAA cross-sectional area (in cm 2 ) divided by height (in meters) is greater than 10, this would be another indication for intervention. 2 This threshold was derived from studies from Cleveland Clinic originally applied to patients with bicuspid aortic valves and Marfan syndrome, 19,20 and more recently in all TAA patients, 21 with major prognostic implications (Figure 4).…”

Novel Approaches for BAV Aortopathy Prediction—Is There a Need for Cohort Studies and Biomarkers?

“…Any proximal aortic disease that is associated with a maximum aortic diameter > 40 mm and/or an indexed aortic diameter exceeding 21 mm/m 2 , respectively, is defined as aortopathy [ 9 ]. Other authors postulated the benefit of using indexed aortic area (i.e., aortic root or ascending aorta area divided by the body height) to define a clinically-relevant aortopathy [ 10 ].…”