Cardiac damage stages and prognosis in patients with bicuspid versus tricuspid aortic valve: insights from the CURRENT AS Registry-2.

Cardiac damage staging is a validated predictor of outcomes in tricuspid aortic valve aortic stenosis (TAV-AS), but its role in bicuspid aortic valve aortic stenosis (BAV-AS) remains unclear. We compared baseline characteristics, cardiac damage stages, and clinical outcomes between BAV-AS and TAV-AS patients. We analyzed 3365 patients with severe aortic stenosis (AS) from the CURRENT AS Registry-2, including 222 with BAV-AS and 3143 with TAV-AS. Cardiac damage stages were classified based on index echocardiographic findings. The primary outcome was a composite of death or heart failure hospitalization. BAV-AS patients were significantly younger and had fewer cardiovascular comorbidities than TAV-AS patients. Despite greater AS severity, BAV-AS patients more often presented with less advanced cardiac damage (stage 0–1: 53% versus 29%, P < 0.001). Among patients aged < 75 years, early-stage cardiac damage was more prevalent in BAV-AS, whereas TAV-AS patients aged < 75 years showed higher rates of advanced cardiac damage. The cumulative 3-year incidence of the primary outcome was significantly lower in BAV-AS than in TAV-AS (9.9% versus 38.4%, P < 0.001). Adjusted analysis confirmed that BAV-AS remained significantly associated with better outcome (hazard ratio: 0.53, 95% confidence interval: 0.33–0.86, P = 0.01). BAV-AS patients exhibited more favorable baseline profiles, less advanced cardiac damage, and better prognosis despite greater AS severity, highlighting the prognostic value of cardiac damage staging irrespective of valve morphology.