Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography · 2007
Clinical outcome and echocardiographic predictors of aortic valve replacement in patients with bicuspid aortic valve.
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Ahmed Shaheeda, Honos George N, Walling Anne D, Michel Caroline M, Sebag Igal A, Rudski Lawrence G, Therrien Judith
Аннотация
BACKGROUND: Clinical outcomes and echocardiographic parameters associated with aortic valve replacement (AVR) for bicuspid aortic valve are scarce.
METHODS: We conducted retrospective analysis of 208 adults with bicuspid aortic valve referred for transthoracic echocardiograms.
RESULTS: The Kaplan-Meier survival free of death or need for cardiac surgery was 72% at 5 years. Cardiac surgery was performed in 19%, the majority (68%) for symptomatic aortic stenosis. Peak gradient 80 mm Hg or greater (hazard ratio 11.8, 95% confidence interval 3.7-37.8, P < .0001) and aortic valve area less than or equal to 0.75 cm(2) (hazard ratio 2.9, 95% confidence interval 1.0-8.5, P = .05) predicted the need for AVR. Patients with a large (54%) versus normal left ventricular outflow tract dimension underwent AVR for symptomatic aortic stenosis at a larger calculated aortic valve area (1.07 +/- 0.21 vs 0.75 +/- 0.18 cm(2), P < .0001) but at a similar peak gradient and velocity ratio (76 +/- 19 vs 76 +/- 22 mm Hg, P = not significant; 0.23 +/- 0.06 vs 0.26 +/- 0.12, P = not significant, respectively).
CONCLUSIONS: Clinical events are common among patients with bicuspid aortic valve. Peak gradient 80 mm Hg or more and aortic valve area less than or equal to 0.75 cm(2) predicts the need for AVR. Gradients and velocity ratio better reflect the hemodynamic burden of aortic stenosis in patients with a large left ventricular outflow tract.
METHODS: We conducted retrospective analysis of 208 adults with bicuspid aortic valve referred for transthoracic echocardiograms.
RESULTS: The Kaplan-Meier survival free of death or need for cardiac surgery was 72% at 5 years. Cardiac surgery was performed in 19%, the majority (68%) for symptomatic aortic stenosis. Peak gradient 80 mm Hg or greater (hazard ratio 11.8, 95% confidence interval 3.7-37.8, P < .0001) and aortic valve area less than or equal to 0.75 cm(2) (hazard ratio 2.9, 95% confidence interval 1.0-8.5, P = .05) predicted the need for AVR. Patients with a large (54%) versus normal left ventricular outflow tract dimension underwent AVR for symptomatic aortic stenosis at a larger calculated aortic valve area (1.07 +/- 0.21 vs 0.75 +/- 0.18 cm(2), P < .0001) but at a similar peak gradient and velocity ratio (76 +/- 19 vs 76 +/- 22 mm Hg, P = not significant; 0.23 +/- 0.06 vs 0.26 +/- 0.12, P = not significant, respectively).
CONCLUSIONS: Clinical events are common among patients with bicuspid aortic valve. Peak gradient 80 mm Hg or more and aortic valve area less than or equal to 0.75 cm(2) predicts the need for AVR. Gradients and velocity ratio better reflect the hemodynamic burden of aortic stenosis in patients with a large left ventricular outflow tract.
Предметные рубрики MeSH
AdultAgedAged, 80 and overAortic ValveAortic Valve InsufficiencyCanadaEchocardiography, TransesophagealFemaleHeart Valve ProsthesisHeart Valve Prosthesis ImplantationHumansMaleMiddle AgedOutcome Assessment, Health CarePrognosisRisk AssessmentRisk FactorsSurvival AnalysisSurvival RateTreatment Outcome