Elsevier

The American Journal of Cardiology

Volume 184, 1 December 2022, Pages 96-103
The American Journal of Cardiology

Anatomical and Clinical Factors Associated With Valvulopathy and Aortopathy in Mexican Patients With Bicuspid Aortic Valves

https://doi.org/10.1016/j.amjcard.2022.08.034Get rights and content

The bicuspid aortic valve (BAV) is associated with significant aortic valve dysfunction. We aimed to study Mexican patients with BAV to assess phenotypic expressions of BAV, and associations of valvulopathy and aortopathy and their predictors. A cross-sectional, retrospective study was designed. The patients were divided according to (1) normally or minimally dysfunctional BAV, (2) predominant aortic regurgitation (AR), and (3) predominant aortic stenosis (AS). A total of 189 patients were included with a high prevalence of males (68%). The overall median age was 42 (23 to 52) years. The distribution of fused BAV phenotypes was right-left fusion (77%), right noncoronary fusion (17%) and left noncoronary fusion (6%). AS-predominant group was the oldest with a high prevalence of hypertension, type 2 diabetes mellitus (T2DM), and raphe. In multivariable analysis T2DM (odds ratio [OR] 10.5 [95% confidence interval (CI) 2.1 to 52], p <0.01) and presence of raphe (OR 2.58 [95% CI 1.02 to 6.52], p = 0.04) were independently associated with AS. The AR-predominant group was composed mostly of males with significantly fewer cardiovascular risk factors. Male gender (OR 2.84 [95%CI 121 to 6.68], p = 0.01) and aortic dilatation (OR 3.58 [95% CI 1.73 to 7.39], p <0.01) were associated with AR-predominance in multivariable analysis. Aortic dilatation was associated with age (OR 1.03 [95% CI 1.008 to 1.05], p <0.01) and AR (OR 4.31 [95% CI 2.05 to 9.06], p <0.01). Independent factors associated with the root phenotype were male gender (OR 12.4 [95% CI 1.6 to 95], p <0.01) and AR (OR 5.25 [95% CI 2.18 to 12.6], p <0.01).In conclusion, in a mestizo population, the distribution of BAV-fused phenotypes was similar to European and North American populations, the presence of raphe and T2DM were independently associated with AS-predominance, and male gender and aortic dilatation were independently associated with AR-predominance.

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.

Section snippets

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.

References (29)

  • P Mathieu et al.

    The pathology and pathobiology of bicuspid aortic valve: state of the art and novel research perspectives

    J Pathol Clin Res

    (2015)
  • A Evangelista et al.

    Anatomical and clinical predictors of valve dysfunction and aortic dilation in bicuspid aortic valve disease

    Heart (Br Card Soc)

    (2018)
  • WK Kong et al.

    Prognostic implications of raphe in bicuspid aortic valve anatomy

    JAMA Cardiol

    (2017)
  • WKF Kong et al.

    Inter-ethnic differences in valve morphology, valvular dysfunction, and aortopathy between Asian and European patients with bicuspid aortic valve

    Eur Heart J

    (2018)
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