Aortic distensibility was similar in BAV and TAV patients and showed no link with LV remodeling, but BAV patients had a significant negative correlation between distensibility and Zva (ρ=-0.615, p=0.0
Does bicuspid aortic valve impact aortic distensibility and LV remodelling compared to tricuspid aortic valve in patients with severe symptomatic aortic stenosis?
In patients with severe symptomatic aortic stenosis, aortic distensibility is similar between those with bicuspid and tricuspid aortic valves and does not correlate with LV remodeling, although BAV patients exhibit a distinct negative correlation between distensibility and valvulo-arterial impedance.
Abstract Introduction Ventricular adaptation to aortic stenosis (AS) is influenced by both valve obstruction and overall vascular load. Bicuspid aortic valve (BAV) is associated with intrinsic aortopathy, impacting aortic stiffness. We aimed to compare aortic stiffness, using distensibility as its surrogate marker, between AS patients with BAV and tricuspid aortic valve (TAV) and to assess its impact on LV remodelling. Methods Single-centre, prospective cohort study of 158 patients with severe symptomatic AS (71±8 years, 50% male; mean transaortic gradient 61±17mmHg, mean indexed aortic valve area 0.4±0.1cm2/m2 and mean LV ejection fraction 58±9%) referred for SAVR between 2019 and 2022. Patients with previous cardiomyopathy, concomitant moderate/severe aortic regurgitation and severe non-AS valvulopaty were excluded. All participants underwent transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) before SAVR. Valve morphology was determined from TTE or surgical operative reports. Average systolic and diastolic ascending aortic (AA) dimensions were measured at cine images on the horizontal three-chamber and coronal left ventricular outflow views, at the level of pulmonary artery bifurcation. Maximum and minimum aortic areas were then inferred and aortic distensibility calculated. Relative aortic valve load (VL) and valvulo-arterial impedance (Zva) were calculated and correlated with aortic distensibility. LV ventricular geometric remodelling, defined from CMR, was assessed according to valve morphology and aortic distensibility. Results A total of 123 patients were included (71 yearsIQR 9; 50% male), 13% with BAV, and 87% with TAV (25 patients with undetermined valve morphology). All patients had normal flow/high gradient AS, and BAV cases exhibited the ascending phenotype without root involvement. BAV patients were younger, with lower prevalence of hypertension and with higher prevalence of aortopathy. AS severity indexes were similar between groups, except for higher mean transvalvular gradients in BAV-Table 1. BAV patients exhibited higher aortic distensibility and VL, though these differences were not statically significant. Zva values were comparable between groups-Table 2. A negative correlation was found between distensibility and Zva in BAV patients (ρ=-0.615, p=0.011) but not in the TAV group (ρ=-0.151, p=0.122)-Figure 2. LV geometric remodelling had no significant correlation with aortic distensibility in both group of patients (ρ -0.114 p=0.246 in BAV and ρ 0.137, p=0.264 in TAV). Conclusion Aortic distensibility was similar between BAV and TAV patients and showed no association with LV remodelling in either group. However, in BAV patients there was a significant negative correlation between distensibility and Zva, favouring a distinct ventricular-valvular and vascular relationship in this subgroup.Aortic Distensibility: BAV vs TAV
Correia et al. (2025) studied this question. Aortic distensibility was similar in BAV and TAV patients and showed no link with LV remodeling, but BAV patients had a significant negative correlation between distensibility and Zva (ρ=-0.615, p=0.0.