Abstract 11969: Effect of Aortic Valve Phenotype and Sex on Aortic Dilation: Results From the Progressa Study

Abstract

Introduction: Bicuspid aortic valve (BAV) is frequently associated with aortic valve stenosis (AS) and concomitant aortopathy. However, few studies have evaluated the effect of aortic valve (AV) phenotype on the risk of progressive dilation of aorta dimensions. The aim of this study was to compare the progression rate of aorta dimensions according to AV phenotype (i.e. BAV vs tricuspid aortic valve [TAV]) and sex in patients with AS. Methods: Three-hundred twenty AS patients (231 TAV and 89 BAV; mean age: 64±14 years, 72% men) recruited in the PROGRESSA study (NCT01679431) were included in this analysis. Patients underwent Doppler-echocardiography annually to measure the AS hemodynamic severity and aorta dimensions including the aortic root (AR) at the sinus level and ascending aorta (AA) sections. The annualized change of echocardiographic parameters was assessed between baseline and last follow-up visit (median follow-up time: 4.01 [2.26 to 5.00] years). Results: Baseline AR diameters were similar between phenotypes and AA diameters were larger in BAV vs. TAV (34±5 vs. 34±4, p=0.43, 38±6 vs. 34±4, p<0.001, respectively). Median change in AR root diameter was similar in BAV vs. TAV (0.15 [-0.07 to 0.44] cm/year vs. 0.13 [-0.07 to 0.41] cm/year, p=0.69), whereas AA annualized change was larger in BAV (0.26 [0.02 to 0.52] cm/year vs. 0.14 [-0.06 to 0.40] cm/year, p=0.02). After multivariable adjustment, BAV phenotype was not a significant predictor of faster progression rate of AR or AA dilation (β: -0.003, p=0.98 and -0.095, p=0.25). In a separate analysis according to sex, the median changes in AR and AA were similar between women and men (p=0.53 and p=0.18). Predictors of AA progression rate in men were baseline AA diameter and AS severity (i.e. baseline peak aortic jet velocity) (all p≤0.03). In women, only higher low-density lipoprotein levels were significantly associated with faster AA progression (p=0.02). Regarding the AR annualized dilation, there were no significant predictors in both women and men (all p≥0.07). Conclusion: This study suggests that AV phenotype is not independently associated with faster dilation of the AR or AA in patients with established AS. However, the determinants of aorta dilation may be different between women and men.