Bicuspid aortic valve in significant aortic stenosis was associated with less LV hypertrophy than tricuspid valves; concentric remodeling predicted death or AVR in BAV (HR 1.61, 95% CI 1.08-2.39).
Cohort (n=3,720)
Yes
Does bicuspid aortic valve compared to tricuspid aortic valve affect left ventricular remodeling patterns and the composite outcome of death or aortic valve replacement in patients with significant aortic stenosis?
In patients with significant aortic stenosis, bicuspid aortic valves are associated with less LV hypertrophy compared to tricuspid valves, and the prognostic impact of specific LV remodeling patterns differs between the two etiologies.
Abstract Introduction Left ventricular (LV) remodeling is a key adaptive response to the pressure overload caused by aortic stenosis (AS), with established prognostic implications. However, whether AS due to bicuspid aortic valve (BAV), has different impact on LV remodeling as compared to tricuspid aortic valve (TAV) remains poorly defined. Purpose To investigate differences in LV remodeling patterns between BAV and TAV in patients with significant AS, and to evaluate their respective associations with adverse clinical outcomes. Methods From a multicentre registry, adult patients with BAV or TAV presenting with moderate or severe AS at index echocardiography were included and compared. Those with moderate or severe aortic regurgitation were excluded. LV hypertrophy was defined as a LV mass index of 115 g/m2 in males and 95 g/m2 in females. Furthermore, LV remodeling pattern was classified as: (i) normal geometry (no LV hypertrophy, relative wall thickness RWT ≤0.42); (ii) concentric remodeling (no LV hypertrophy, RWT0.42); (iii) concentric hypertrophy (LV hypertrophy, RWT0.42); and (iv) eccentric hypertrophy (LV hypertrophy, RWT≤0.42). Propensity score matching between BAV and TAV was performed based on age, sex and peak aortic velocity/AS severity. The primary outcome was death or aortic valve replacement (AVR). Results A total of 3720 patients with significant AS (mean age 69±14 years, 42% female) were included, of which 1260 had BAV and 2460 had TAV. The matching produced 614 pairs. BAV patients were younger, more often male, and had fewer comorbidities (Figure1). After propensity matching, clinical characteristics were balanced between groups. Before matching, compared to TAV-AS, BAV-AS showed similar LV end-diastolic diameter but lower wall thickness, resulting in a lower LV mass index, less LV hypertrophy, and reduced RWT, but these differences were no longer significant after matching. However, in the adjusted linear and logistic regression for LV mass index and remodeling patterns, BAV was significantly associated with lower LV mass index, and lower likelihood of LV hypertrophy, concentric and eccentric hypertrophy (Figure 2). In multivariable Cox regression in BAV-AS adjusting for age, sex, comorbidities, significant mitral regurgitation, peak aortic velocity, aortopathy, LV ejection fraction and left atrial volume, only concentric remodeling (vs. normal geometry: HR 1.61, 95% CI 1.08-2.39, P = 0.019) was independently associated with death or AVR. In contrast, both eccentric hypertrophy (HR 1.36, 95% CI 1.07-1.74, P = 0.013) and concentric remodeling (HR 1.33, 95% CI 1.05-1.67, P = 0.016) were significant predictors in TAV-AS. Conclusions In a large cohort of patients with significant AS, BAV patients presented with less LV hypertrophy compared to TAV. In BAV-AS, only concentric remodeling was associated with worse outcome, while in TAV-AS, both eccentric hypertrophy and concentric remodeling were associated with worse outcome.
He et al. (2026) conducted a cohort in significant aortic stenosis (n=3,720). Bicuspid aortic valve vs. Tricuspid aortic valve was evaluated on death or aortic valve replacement (AVR). Bicuspid aortic valve in significant aortic stenosis was associated with less LV hypertrophy than tricuspid valves; concentric remodeling predicted death or AVR in BAV (HR 1.61, 95% CI 1.08-2.39).