Retrospective study to identify predictors of the presence and rapid progression of aortic dilatation in patients with bicuspid aortic valves.

BACKGROUND

Aortic dilatation is common among adults with bicuspid aortic valves (BAV). Predictors of risk and progression of aortic dilatation are not well described in this setting.

METHODS

We analyzed retrospective data on the presence of dilation in several aortic segments in 156 adult patients with BAV who had serial echocardiograms performed at least 1 year apart. Various risk factors for the presence and progression of aortic dilatation were identified.

RESULTS

Mean echocardiographic follow-up was 3.8 +/- 1.4 years, yielding a total of 582 patient-years. Independent predictors of having a dilated aorta at baseline were age (odds ratio [OR] 1.06, 95% CI 1.03-1.09), body surface area (OR 8.78, 95% CI 1.08-71.70) and moderate to severe aortic regurgitation (OR 6.38, 95% CI 2.51-16.20). During echocardiographic follow-up, 16 (15.2%) patients developed dilatation (incidence 4 cases per 100 patient-years). Mean annual rates of progression were estimated at 0.37 mm (95% CI 0.17-0.57), 0.18 mm (95% CI 0.05-0.31), 0.17 mm (95% CI 0.06-0.29) and 0.18 mm (95% CI 0.05-0.31) for the ascending aorta, sinotubular junction, aortic sinus and aortic annulus, respectively. Fusion of the right and left valve leaflets was associated with rapid aortic dilatation (OR 2.92, 95% CI 1.15- 7.41) whereas prior coarctation repair was associated with protection from rapid aortic dilatation (OR 0.13, 95% CI 0.04-0.40).

CONCLUSIONS

Patients with BAV and increased age, high body surface area and moderate to severe aortic regurgitation are more likely to have a dilated aorta. Patients with right-to-left leaflet fusion are at increased risk of rapid aortic dilatation.