Anatomical and Clinical Factors Associated With Valvulopathy and Aortopathy in Mexican Patients With Bicuspid Aortic Valves
Introduction
Bicuspid aortic valve (BAV) is a valvulo-aortopathy with heterogeneous phenotypes and clinical outcomes.1 The most prevalent complication is valvulopathy (organic valve injury), most commonly severe aortic stenosis (AS).1 Aortopathy (mainly aortic dilatation) and aortic regurgitation (AR) are the next most common complications. The abnormal BAV anatomy causes turbulent flow and high tissular stress2; this injury may initiate the process of inflammation, neovascularization, and oxidized lipid retention that promotes mineralization and calcification.2 Therefore, it has been proposed that atherosclerotic and inflammation factors appear to be involved in the BAV AS genesis.3,4 Importantly, these associations have been derived from European and Asian populations; but in Latin-American populations it is unknown. In addition, inter-ethnic differences in valvulo-aortopathy phenotypic expression have been reported,5 furthermore, the race has been proposed as a potential disease modifier in BAV.6 Mexico has a mestizo population; a pluri-ethnic mixture of indigenous, European, and African ancestry,7 and this class of mestizo population is closely similar to that found in most Latin-American countries. We aimed to study consecutive Mexican patients with BAV to assess BAV phenotypic expressions, as well as valvulopathy and aortopathy associations and their predictors.
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Methods
A cross-sectional, retrospective study was designed within the National Institute of Cardiology Ignacio Chavez, in Mexico City, a large inner-city health center. We identified all consecutive patients who received an echocardiographic diagnosis of BAV in our echocardiography laboratory between January 1, 2016 and December 31, 2018. Patients with an uncertain diagnosis of BAV, endocarditis history, inflammatory rheumatologic disease, history of rheumatic fever, or chest radiation were all
Results
A total of 268 patients received an echocardiographic diagnosis of BAV during the study period and we excluded 79 patients for different reasons. Figure 1. After exclusions, a total of 189 patients were analyzed. The complete demographic and echocardiographic data are shown in Table 1. The normal-function group (n = 56) had a median peak aortic velocity of 1.8 m/s and ≤mild AR; the predominant-AR group (n = 48) had a peak aortic velocity of 1.9 m/s with 25 patients exhibiting moderate AR and 23
Discussion
This rigorous cross-sectional study addresses the anatomical and clinical predictors of BAV valvulopathy and aortopathy in a Mexican population, representative of most Latin-American countries. Our principal findings in this population are: (1) the distribution of BAV-fused phenotypes (left-right fusion 77%, R-N 17%, and L-N 6%) was similar to European5 and North American16,17 populations; (2) the presence of raphe (overall 83%) was similar to European and European-descent populations4; (3) the
Disclosures
The authors have no conflicts of interest to declare.
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