Determinants and prognostic significance of symptomatic status in patients with moderately dysfunctional bicuspid aortic valves

Abstract

We aimed to identify the clinical and echocardiographic determinants of symptom status and its prognostic implication in patients with moderately dysfunctional bicuspid aortic valves (BAVs). Among 1019 subjects in the BAV registry in a single tertiary care center, 128 patients (86 men, age 58±13 years) with moderately dysfunctional BAVs were comprehensively reviewed. The patients were divided into two groups based on their symptom status: asymptomatic (n=80) vs. symptomatic (n=48). The primary end-point was defined as a composite of aortic valve surgery, hospitalization for heart failure, and any cause of death. The symptomatic group was to have a higher proportion of females, hypertension, aortic stenosis, and aortopathy than the asymptomatic group. The symptomatic group showed lower e′ (5.5±1.7 vs. 6.5±2.2cm/s, p=0.003), higher E/e′ (13.2±4.8 vs.10.9±3.7, p=0.002), and larger left atrial volume index (29.5±11.5 vs. 24.6±9.1 ml/m2, p=0.014) than the asymptomatic group. In the multivariable logistic regression, female (odds ratio [OR] 2.61, 95% confidence interval [CI] 1.03–6.53, p=0.041), hypertension (OR 2.78, 95% CI 1.08–7.21, p=0.032), moderate aortic stenosis (OR 5.33, 95% CI 1.89–15.01, p=0.002), E/e′>15 (OR 2.88, 95% CI 1.04–7.98, p=0.042), and aortopathy (OR 2.53, 95% CI 1.01–6.33, p=0.047) were independently correlated with symptom status. The symptomatic group showed a significantly lower event-free survival during the overall 8 years (51±9 vs. 69±8%, p=0.001). In moderately dysfunctional BAVs, the presence of moderate aortic stenosis, aortopathy, and diastolic dysfunction determines symptom status along with female gender and hypertension. Symptom status is associated with clinical outcomes.