Extent of Coronary Artery Disease in Patients With Stenotic Bicuspid Versus Tricuspid Aortic Valves

Abstract

Background Bicuspid aortic valve (BAV) is the most common congenital cardiac malformation, which is often complicated by aortic valve stenosis (AoS). In tricuspid aortic valve (TAV), AoS strongly associates with coronary artery disease (CAD) with common pathophysiological factors. Yet, it remains unclear whether AoS in patients with BAV is also associated with CAD. This study investigated the association between the aortic valve morphological features and the extent of CAD. Methods and Results A single‐center study was performed, including all patients who underwent an aortic valve replacement attributable to AoS between 2006 and 2019. Coronary sclerosis was graded on preoperative coronary angiographies using the coronary artery greater even than scoring method, which divides the coronaries in 28 segments and scores nonobstructive (20%–49% sclerosis) and obstructive coronary sclerosis (>49% sclerosis) in each segment. Multivariate analyses were performed, controlling for age, sex, and CAD risk factors. A total of 1296 patients (931 TAV and 365 BAV) were included, resulting in 548 matched patients. Patients with TAV exhibited more CAD risk factors (odds ratio [OR], 2.66; 95% CI, 1.79–3.96; P <0.001). Patients with BAV had lower coronary artery greater even than 20 (1.61±2.35 versus 3.60±2.79) and coronary artery greater even than 50 (1.24±2.43 versus 3.37±3.49) scores ( P <0.001), even after correcting for CAD risk factors ( P <0.001). Patients with TAV more often needed concomitant coronary revascularization (OR, 3.50; 95% CI, 2.42–5.06; P <0.001). Conclusions Patients with BAV who are undergoing surgery for AoS carry a lower cardiovascular risk profile, correlating with less coronary sclerosis and a lower incidence of concomitant coronary revascularization compared with patients with TAV.

Comparative evaluation of coronary disease burden: bicuspid valve disease is not atheroprotective

“…Comparison of echocardiographic characteristics were already made in a previous study, which showed higher aortic valve gradients in BAV patients (peak gradient of 73 vs 62 mm Hg, p<0.001). 3 Subanalysis showed a higher prevalence of risk factors hypercholesterolaemia and diabetes mellitus in TAV-AoS vs TAV-AR (both p<0.001), as well as with a higher prevalence of previous CAD (corrected OR (age and sex) for TAV-AR vs TAV-AoS: 1.08 (95% CI 1.06 to 1.10); p=0.001). Comparison of BAV-AoS patients with BAV-AR patients only showed a higher prevalence of diabetes mellitus in BAV-AoS patients (p<0.001).…”

“…All included hospital patients were surgically treated between 2006 and 2019 and were obtained from a retrospective study conducted at the Leiden University Medical Center (LUMC) in the Netherlands. 3 Patient consent was waived. Subsequently, the atherosclerotic disease burden of each group was compared with that of the corresponding (matched) age cohort for the general population.…”

“…Preoperative coronary angiographies were scored for all hospital patients, 3 but could not be used to compare CAD with the general population since angiographies were not available for this group. Therefore, it was chosen to define CAD in the general population as a previous myocardial infarction or instable angina pectoris.…”

“…Deduplication was performed for the hospital patients that had a history of both a myocardial infarction and instable angina pectoris. 3 Cardiovascular risk factors included hypertension, diabetes mellitus (types 1 and 2) and hypercholesterolaemia. Current guidelines define hypertension as a blood pressure of ≥140/90 mm Hg.…”

“…Data regarding the BAV and TAV hospital patients were from a single centre cohort of 1555 (454 BAV, 1101 TAV) patients who underwent aortic valve repair or replacement. 3 The medical history of these patients were all re-evaluated for the prevalence of CAD and risk factors.…”