Abstract 2126: Rapid Aortic Dilatation in Adult Patients with a Bicuspid Aortic Valve is Associated with Risk Factors for Coronary Artery Disease
Background: Patients with bicuspid aortic valves (BAV) often have larger aortic size than normals. The association between rapid aortic dilatation and atherosclerotic risk factors has not been studied in this population. The effect of hemodynamic factors has been studied with conflicting results. We identified adults with BAV and rapid aortic dilatation and assessed its association with hemodynamic and atherosclerotic risk factors.
Methods: Using the Dartmouth-Hitchcock echocardiographic database between 1997 and 2005, 75 patients with BAV were identified and divided into two groups: rapid progressors (RP, n=28) and slow progressors (SP, n=47). All study subjects had a baseline echocardiogram and at least one follow-up study performed ≥1 year. Aortic size was measured at the sinus and ascending aorta level with rapid progression defined as an adjusted annual rate of progression ≥ 90th percentile for the entire cohort. The association of rapid aortic dilatation with the following characteristics was evaluated: age, gender, body surface area (BSA), presence of coronary artery disease (CAD), HDL, LDL, cholesterol, smoking, diabetes, glucose, systolic blood pressure, diastolic blood pressure, National Heart, Lung and Blood Institute’s 10-year risk of developing coronary heart disease (10 year risk score) and the presence and severity of aortic regurgitation (AR) and aortic stenosis (AS).
Results: Compared to the SP, the RP had higher mean random glucose values (136.2 ± 21 mg/dl vs. 114.5 ± 25.2 mg/dl, p<0.001), more CAD (53.5% vs. 17.0%, p<0.001), a higher 10 year risk score (11.2 ± 7.2% vs. 5.7 ± 5.2%, p<0.001), and had a lower HDL (46.8 ± 11.7 mg/dl vs. 56.1 ± 18.0 mg/dl, p<0.005). There was no difference in the prevalence or severity of AS or ≥2+ AR between the two groups. A 10 year risk score ≥11% was an independent predictor of rapid aortic dilatation (OR 13.4, p<0.01). Receiver operator characteristic analysis showed a 10 year risk score = 10% as the optimum cutoff (sensitivity 60.7%, specificity 78.7%, OR 5.7, 95% CI 2.0–16.0).
Conclusions: In adult patients with BAV, the presence of CAD, hyperglycemia, low HDL, and an elevated 10 year risk score are associated with rapid aortic dilatation with an elevated 10 year risk score being an independent predictor.