Abstract 12137: Predictors of Ascending Aortic Dilation in Subjects With Bicuspid Aortic Valve - A Five Year Prospective Study
Background: Bicuspid aortic valve (BAV), the most common congenital cardiac abnormality in adults, is associated with aortic dilation and dissection. There is a paucity of prospective studies with serial echocardiograms evaluating aortic dilation in adult subjects with BAV. In our prospective study, we evaluated clinical and echocardiographic variables to identify predictors of progressive aortic dilation among asymptomatic adult subjects with BAV.
Methods: A total of 115 subjects with BAV were enrolled from 2003-2008. Subjects who had fewer than 3 years of follow up were excluded, with 90 subjects remaining. Ascending aortic diameter was measured at baseline and annually thereafter.
Results: Aortic size increased in 71.1% of subjects (mean 0.66±0.05 mm/year; range 0.2-2.3 mm/yr) over a mean follow up of 4.8 years. In 15.6% of subjects the rate of change exceeded 1mm/yr. The average rate of ascending aortic dilation for all subjects was 0.47±0.05 mm/ year (p≤0.001). 6 subjects had an eventual aortic valve replacement. Although a history of hypertension was inversely associated with aortic dilation (0.54 mm/yr with vs 0.30 mm/yr without, p=0.022); it was not an independent predictor. Family history of aortic valve disease was associated with progression in both unadjusted (p=0.029) and logistic regression analysis adjusted for age, gender, and body surface area (OR 13.7, p=0.021). A multivariate analysis did not find leaflet orientation or moderate to severe aortic valve dysfunction as independent predictors of aortic dilation.
Conclusion: We found that in subjects with BAV, studied prospectively, there was an annual rate of proximal aortic dilation of 0.47 mm/year, consistent with rates previously described. In contrast to previous reports, leaflet orientation or aortic valve dysfunction were not independent predictors of aortic dilation. Family history of aortic valve disease is associated with significantly increased risk of progressive aortic dilation.
- © 2013 by American Heart Association, Inc.