Pace of progression of aortic stenosis severity in patients with tricuspid and bicuspid valve

Abstract

Abstract Background Knowledge about determinants and pace of aortic stenosis (AS) progression may improve classification to aortic valve replacement. We quantified and compared pace of AS progression in patients with tricuspid and bicuspid aortic valve (TAV and BAV) examined by transthoracic echocardiography (TTE) in years 2004–2019. Methods We analysed retrospectively 322 TTE performed in two time points (median time between examinations 31±31 months) in 161 AS patients (mean age 69±11 years, 101 male, 40 BAV), evaluating the changes of parameters reflecting AS severity: peak pressure gradient (PG), aortic valve area by planimetry (AVApl) and continuity equation (AVAce). Then we compared pace of AS progression (defined as change of parameters per year) between patients with BAV and TAV and searched for correlates of AS progression. Results Although patients with BAV were younger, cardiovascular risk factors profile and baseline AS advancement were similar in both groups, see Table. Severe AS was present in 20% in BAV and 21% in TAV, p=ns. Patients with BAV showed circa 3 times more rapid AS progression expressed as the increase of PG per year (18.5±41.3 mmHg vs 4.1±34.4 mmHg in TAV, p=0.03) and yearly AVAce decrease (−0.23±0.27 vs −0.03±0.32, p=0.028). Smaller AVA value at baseline predicted faster pace of AS progression (with correlation coefficient r=−0.34, p=0.002 for AVApl). Conclusion Progression rate of AS depends on valve morphology being more rapid in BAV with similar to TAV baseline AS severity. In the whole group pace of progression correlated negatively with baseline AVA. Funding Acknowledgement Type of funding source: None