Left ventricular remodelling in bicuspid aortic valve disease

被引：15

作者：

Butcher, Steele C. ^{[1
,2
]}

Pio, Stephan M. ^{[1
]}

Kong, William K. F. ^{[1
,3
]}

Singh, Gurpreet K. ^{[1
]}

Ng, Arnold C. T. ^{[4
]}

Perry, Rebecca ^{[5
]}

Sia, Ching-Hui ^{[3
]}

Poh, Kian Keong ^{[6
]}

Almeida, Ana G. ^{[7
]}

Gonzalez, Ariana ^{[8
]}

Shen, Mylene ^{[9
]}

Yeo, Tiong Cheng ^{[3
]}

Shanks, Miriam ^{[10
]}

Popescu, Bogdan A. ^{[11
]}

Gay, Laura Galian ^{[12
]}

Fijalkowski, Marcin ^{[13
]}

Liang, Michael ^{[3
,14
]}

Tay, Edgar ^{[4
]}

Marsan, Nina Ajmone ^{[1
]}

Selvanayagam, Joseph ^{[5
]}

Pinto, Fausto ^{[6
]}

Zamorano, Jose L. ^{[7
]}

Pibarot, Philippe ^{[8
]}

Evangelista, Arturo ^{[11
]}

Bax, Jeroen J. ^{[1
,15
,16
]}

Delgado, Victoria ^{[1
]}

机构：

[1] Leiden Univ, Heart Lung Ctr, Dept Cardiol, Med Ctr, Albinusdreef 2, NL-2300 RC Leiden, Netherlands

[2] Royal Perth Hosp, Dept Cardiol, 197 Wellington St, Perth, WA 6000, Australia

[3] Natl Univ Hlth Syst, Natl Univ Heart Ctr, Dept Cardiol, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore

[4] Univ Queensland, Princess Alexandra Hosp, Dept Cardiol, 199 Ipswich Rd, Woolloongabba, Qld 4102, Australia

[5] Flinders Med Ctr, Dept Cardiovasc Med, Flinders Dr, Adelaide, SA 5042, Australia

[6] Natl Univ Singapore, Yong Loo Lin Sch Med, 10 Med Dr, Singapore 117597, Singapore

[7] Univ Lisbon, Santa Maria Univ Hosp CHLN, Cardiol Dept, Lisbon Sch Med,CAML,CCUL, Av Prof Egas Moniz MB, P-1649028 Lisbon, Portugal

[8] Hosp Univ Ramon y Cajal, Dept Cardiol, M-607,9,100, Madrid 28034, Spain

[9] Laval Univ, Quebec Heart & Lung Inst, 2725 Ch Ste Foy, Quebec City, PQ G1V 4G5, Canada

[10] Univ Alberta, Mazankowski Alberta Heart Inst, Div Cardiol, 11220 83 Ave NW, Edmonton, AB T6G 2B7, Canada

[11] Univ Med & Pharm Carol Davila, Inst Cardiovasc Dis Prof Dr CC Iliescu, Euroecolab, Bulevardul Eroii Sanitari 8, Bucharest 050474, Romania

[12] Hosp Univ Vall dHebron, Dept Cardiol, Passeig Vall dHebron 119, Barcelona 08035, Spain

[13] Med Univ Gdansk, Dept Cardiol 1, Marii Sklodowskiej Curie 3a, PL-80210 Gdansk, Poland

[14] Khoo Teck Puat Hosp, Dept Cardiol, 90 Yishun Cent, Singapore 768828, Singapore

[15] Univ Turku, Heart Ctr, Kiinamyllynkatu 4-8, Turku 20521, Finland

[16] Turku Univ Hosp, Kiinamyllynkatu 4-8, Turku 20521, Finland

来源：

EUROPEAN HEART JOURNAL-CARDIOVASCULAR IMAGING | 2022年 / 23卷 / 12期

关键词：

bicuspid aortic valve; mixed aortic valve disease; aortic stenosis; aortic regurgitation; LV remodelling; LV geometric pattern; LV mass index; EUROPEAN ASSOCIATION; ECHOCARDIOGRAPHIC-ASSESSMENT; DIASTOLIC FUNCTION; REGURGITATION; RECOMMENDATIONS; OUTCOMES; STENOSIS; ADULTS; MASS; HYPERTROPHY;

D O I：

10.1093/ehjci/jeab284

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims Characterization of left ventricular (LV) geometric pattern and LV mass could provide an important insight into the pathophysiological adaptations of the LV to pressure and/or volume overload in patients with bicuspid aortic valve (BAV) and significant (>= moderate) aortic valve (AV) disease. This study aimed to characterize LV remodelling and its prognostic impact in patients with BAV according to the predominant type of valvular dysfunction. Methods and results In this international, multicentre BAV registry, 1345 patients [51.0 (37.0-63.0) years, 71% male] with significant AV disease were identified. Patients were classified as having isolated aortic stenosis (AS) (n = 669), isolated aortic regurgitation (AR) (n = 499) or mixed aortic valve disease (MAVD) (n = 177). LV hypertrophy was defined as a LV mass index >115 g/m(2) in males and >95 g/m(2) in females. LV geometric pattern was classified as (i) normal geometry: no LV hypertrophy, relative wall thickness (RWT) <= 0.42, (ii) concentric remodelling: no LV hypertrophy, RWT >0.42, (iii) concentric hypertrophy: LV hypertrophy, RWT >0.42, and (iv) eccentric hypertrophy: LV hypertrophy, RWT <= 0.42. Patients were followed-up for the endpoints of event-free survival (defined as a composite of AV repair/replacement and all-cause mortality) and all-cause mortality. Type of AV dysfunction was related to significant variations in LV remodelling. Higher LV mass index, i.e. LV hypertrophy, was independently associated with the composite endpoint for patients with isolated AS [hazard ratio (HR) 1.08 per 25 g/m(2), 95% confidence interval (CI) 1.00-1.17, P = 0.046] and AR (HR 1.19 per 25 g/m(2), 95% CI 1.11-1.29, P < 0.001), but not for those with MAVD. The presence of concentric remodelling, concentric hypertrophy and eccentric hypertrophy were independently related to the composite endpoint in patients with isolated AS (HR 1.54, 95% CI 1.06-2.23, P = 0.024; HR 1.68, 95% CI 1.17-2.42, P = 0.005; HR 1.59, 95% CI 1.03-2.45, P = 0.038, respectively), while concentric hypertrophy and eccentric hypertrophy were independently associated with the combined endpoint for those with isolated AR (HR 2.49, 95% CI 1.35-4.60, P = 0.004 and HR 3.05, 95% CI 1.71-5.45, P < 0.001, respectively). There was no independent association observed between LV remodelling and the combined endpoint for patients with MAVD. Conclusions LV hypertrophy or remodelling were independently associated with the composite endpoint of AV repair/replacement and all-cause mortality for patients with isolated AS and isolated AR, although not for patients with MAVD.

引用

页码：1669 / 1679

页数：11

共 35 条

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