Bicuspid aortic valve morphology and its impact on aortic diameters—A systematic review with meta-analysis and meta-regression
Corresponding Author
Dawid Miśkowiec MD
Department of Cardiology, Medical University of Lodz, Lodz, Poland
Correspondence
Dawid Miśkowiec, Department of Cardiology, Medical University of Lodz, Lodz, Poland.
Email: [email protected]
Search for more papers by this authorPiotr Lipiec MD, PhD
Department of Cardiology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorEwa Szymczyk MD, PhD
Department of Cardiology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorPaulina Wejner-Mik MD, PhD
Department of Cardiology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorBłażej Michalski MD, PhD
Department of Cardiology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorKarolina Kupczyńska MD
Department of Cardiology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorKarina Wierzbowska-Drabik MD, PhD
Department of Cardiology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorJarosław D. Kasprzak MD, PhD
Department of Cardiology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorCorresponding Author
Dawid Miśkowiec MD
Department of Cardiology, Medical University of Lodz, Lodz, Poland
Correspondence
Dawid Miśkowiec, Department of Cardiology, Medical University of Lodz, Lodz, Poland.
Email: [email protected]
Search for more papers by this authorPiotr Lipiec MD, PhD
Department of Cardiology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorEwa Szymczyk MD, PhD
Department of Cardiology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorPaulina Wejner-Mik MD, PhD
Department of Cardiology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorBłażej Michalski MD, PhD
Department of Cardiology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorKarolina Kupczyńska MD
Department of Cardiology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorKarina Wierzbowska-Drabik MD, PhD
Department of Cardiology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorJarosław D. Kasprzak MD, PhD
Department of Cardiology, Medical University of Lodz, Lodz, Poland
Search for more papers by this authorAbstract
Aim
To evaluate the impact of the 2 most common bicuspid aortic valve (BAV) morphology patterns [right-left (RL) vs right-noncoronary (RN) cusp fusion] on the aortic diameters and the impact of gender, aortic stenosis (AS), aortic regurgitation (AR), and age on the observed effects.
Methods
The PubMed databases was searched up to December 31, 2016 to identify studies investigating the morphology of BAV and aortic diameters. Inclusion criteria were as follows: the data on diameter of sinuses of Valsalva (SVD) and/or ascending aorta (AAD) and BAV morphology. The additional characteristics [gender, AS and AR (% of patients with moderate or severe AS/AR) and mean age] were collected to perform a meta-regression analysis.
Results
A total of 12 studies with 2192 patients with indexed AAD, 15 studies with 3104 patients with nonindexed AAD and 8 studies with 1271 patients with indexed SVD, and 16 studies with 3454 patients with nonindexed SVD were included. There was no difference between RL and RN group in indexed/nonindexed AAD—mean difference (MD): 0.06 mm/m2 (95% CI: −0.65 to 0.77 mm/m2, P = .87) and −0.06 mm (95% CI: 1.10–0.97 mm, P = .91). Differently, the RL BAV was associated with larger indexed/nonindexed SVD than RN phenotype—MD: 1.66 mm/m2 (95% CI: 0.83–2.49 mm/m2, P < .001) and 2.03 mm (95% CI: 0.97–3.09 mm, P < .001). Age, gender, AS, and AR had no influence on observed differences.
Conclusions
RL BAV phenotype is associated with larger SVD than RN BAV, and the observed differences are independent from aortic valve dysfunction degree, age, and gender.
Supporting Information
| Filename | Description |
|---|---|
| echo13818-sup-0001-FigS1.pdfPDF document, 505.7 KB | Figure S1. Subgroup analysis including only (A) computed tomogrpahy (CT), (B) cardiac magnetic resonance (CMR), (C) transthoracic echocardiography (TTE) studies—Forest plot diagram for aortic diameter at the level of ascending aorta in different phenotypes of bicuspid aortic valve. Subgroup analysis including only (D) computed tomogrpahy (CT), (E) cardiac magnetic resonance (CMR), (F) transthoracic echocardiography (TTE) studies—Forest plot diagram for aortic diameter at the level of the sinuses of Valsalva in different phenotypes of bicuspid aortic valve |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1Siu SC, Silversides CK. Bicuspid aortic valve disease. J Am Coll Cardiol. 2010; 55: 2789–2800.
- 2Schaefer BM, Lewin MB, Stout KK, et al. The bicuspid aortic valve: an integrated phenotypic classification of leaflet morphology and aortic root shape. Heart. 2008; 94: 1634–1638.
- 3Braverman AC, Güven H, Beardslee MA, Makan M, Kates AM, Moon MR. The bicuspid aortic valve. Curr Probl Cardiol. 2005; 30: 470–522.
- 4Verma S, Siu SC. Aortic dilatation in patients with bicuspid aortic valve. N Engl J Med. 2014; 370: 1920–1929.
- 5Girdauskas E, Borger MA, Secknus M-A, Girdauskas G, Kuntze T. Is aortopathy in bicuspid aortic valve disease a congenital defect or a result of abnormal hemodynamics? A critical reappraisal of a one-sided argument. Eur J Cardiothorac Surg. 2011; 39: 809–814.
- 6Davies RR, Kaple RK, Mandapati D, et al. Natural history of ascending aortic aneurysms in the setting of an unreplaced bicuspid aortic valve. Ann Thorac Surg. 2007; 83: 1338–1344.
- 7Fernandes SM, Sanders SP, Khairy P, et al. Morphology of bicuspid aortic valve in children and adolescents. J Am Coll Cardiol. 2004; 44: 1648–1651.
- 8 Authors/Task Force members, Erbel R, Aboyans V. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014; 35: 2873–2926.
- 9Brandenburg RO, Tajik AJ, Edwards WD, Reeder GS, Shub C, Seward JB. Accuracy of 2-dimensional echocardiographic diagnosis of congenitally bicuspid aortic valve: echocardiographic-anatomic correlation in 115 patients. Am J Cardiol. 1983; 51: 1469–1473.
- 10Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010; 8: 336–341.
- 11Duval S, Tweedie R. Trim and fill: a simple funnel-plot–based method of testing and adjusting for publication bias in meta-analysis. Biometrics. 2000; 56: 455–463.
- 12Kang J-W, Song HG, Yang DH, et al. Association between bicuspid aortic valve phenotype and patterns of valvular dysfunction and bicuspid aortopathy: comprehensive evaluation using MDCT and echocardiography. JACC Cardiovasc Imaging. 2013; 6: 150–161.
- 13Khoo C, Cheung C, Jue J. Patterns of aortic dilatation in bicuspid aortic valve-associated aortopathy. J Am Soc Echocardiogr. 2013; 26: 600–605.
- 14Bissell MM, Hess AT, Biasiolli L, et al. Aortic dilation in bicuspid aortic valve disease: flow pattern is a major contributor and differs with valve fusion type. Circ Cardiovasc Imaging. 2013; 6: 499–507.
- 15Della Corte A, Bancone C, Dialetto G, et al. Towards an individualized approach to bicuspid aortopathy: different valve types have unique determinants of aortic dilatation. Eur J Cardiothorac Surg. 2014; 45: e118–e124; discussion e124.
- 16Miśkowiec DŁ, Lipiec P, Kasprzak JD. Bicuspid aortic valve morphology and its association with aortic diameter – an echocardiographic study. Kardiol Pol. 2016; 74: 151–158.
- 17Schaefer BM, Lewin MB, Stout KK, Byers PH, Otto CM. Usefulness of bicuspid aortic valve phenotype to predict elastic properties of the ascending aorta. Am J Cardiol. 2007; 99: 686–690.
- 18Buchner S, Hülsmann M, Poschenrieder F, et al. Variable phenotypes of bicuspid aortic valve disease: classification by cardiovascular magnetic resonance. Heart. 2010; 96: 1233–1240.
- 19Huang FQ, Le Tan J. Pattern of aortic dilatation in different bicuspid aortic valve phenotypes and its association with aortic valvular dysfunction and elasticity. Heart Lung Circ. 2014; 23: 32–38.
- 20Detaint D, Michelena HI, Nkomo VT, Vahanian A, Jondeau G, Sarano ME. Aortic dilatation patterns and rates in adults with bicuspid aortic valves: a comparative study with Marfan syndrome and degenerative aortopathy. Heart. 2014; 100: 126–134.
- 21Merritt BA, Turin A, Markl M, Malaisrie SC, McCarthy PM, Carr JC. Association between leaflet fusion pattern and thoracic aorta morphology in patients with bicuspid aortic valve. J Magn Reson Imaging. 2014; 40: 294–300.
- 22Mahadevia R, Barker AJ, Schnell S, et al. Bicuspid aortic cusp fusion morphology alters aortic three-dimensional outflow patterns, wall shear stress, and expression of aortopathy. Circulation. 2014; 129: 673–682.
- 23Cecconi M, Manfrin M, Moraca A, et al. Aortic dimensions in patients with bicuspid aortic valve without significant valve dysfunction. Am J Cardiol. 2005; 95: 292–294.
- 24Jackson V, Olsson C, Eriksson P, Franco-Cereceda A. Aortic dimensions in patients with bicuspid and tricuspid aortic valves. J Thorac Cardiovasc Surg. 2013; 146: 605–610.
- 25Shim CY, Cho IJ, Yang W-I, et al. Central aortic stiffness and its association with ascending aorta dilation in subjects with a bicuspid aortic valve. J Am Soc Echocardiogr. 2011; 24: 847–852.
- 26Michałowska IM, Kruk M, Kwiatek P, et al. Aortic pathology in patients with bicuspid aortic valve assessed with computed tomography angiography. J Thorac Imaging. 2014; 29: 113–117.
- 27Lee M, Sung J, Cho SJ, et al. Aortic dilatation and calcification in asymptomatic patients with bicuspid aortic valve: analysis in a Korean health screening population. Int J Cardiovasc Imaging. 2013; 29: 553–560.
- 28Sonoda M, Takenaka K, Uno K, Ebihara A, Nagai R. A larger aortic annulus causes aortic regurgitation and a smaller aortic annulus causes aortic stenosis in bicuspid aortic valve. Echocardiography. 2008; 25: 242–248.
- 29van der Linde D, Rossi A, Yap SC, et al. Ascending aortic diameters in congenital aortic stenosis: cardiac magnetic resonance versus transthoracic echocardiography. Echocardiography. 2013; 30: 497–504.
- 30Habchi KM, Ashikhmina E, Vieira VM, et al. Association between bicuspid aortic valve morphotype and regional dilatation of the aortic root and trunk. Int J Cardiovasc Imaging. 2017; 33: 341–349.
- 31Avadhani SA, Martin-Doyle W, Shaikh AY, Pape LA. Predictors of ascending aortic dilation in bicuspid aortic valve disease: a five-year prospective study. Am J Med. 2015; 128: 647–652.
- 32Ruzmetov M, Shah JJ, Fortuna RS, Welke KF. The association between aortic valve leaflet morphology and patterns of aortic dilation in patients with bicuspid aortic valves. Ann Thorac Surg. 2015; 99: 2101–2107; discussion 2107–2108.
- 33Page M, Mongeon F-P, Khairy P, Stevens L-M, El-Hamamsy I. Abstract 11355: Cusp fusion phenotype is a determinant of ascending aorta dilation rate and pattern among patients with isolated bicuspid aortic valve. Circulation. 2012; 126(Suppl 21): A11355.
- 34Biner S, Rafique AM, Ray I, Cuk O, Siegel RJ, Tolstrup K. Aortopathy is prevalent in relatives of bicuspid aortic valve patients. J Am Coll Cardiol. 2009; 53: 2288–2295.
- 35Garg V, Muth AN, Ransom JF, et al. Mutations in NOTCH1 cause aortic valve disease. Nature. 2005; 437: 270–274.
- 36Barker AJ, Markl M, Bürk J, et al. Bicuspid aortic valve is associated with altered wall shear stress in the ascending aorta. Circ Cardiovasc Imaging. 2012; 5: 457–466.
- 37Hope MD, Hope TA, Meadows AK, et al. Bicuspid aortic valve: four-dimensional MR evaluation of ascending aortic systolic flow patterns. Radiology. 2010; 255: 53–61.
- 38Russo CF, Cannata A, Lanfranconi M, Vitali E, Garatti A, Bonacina E. Is aortic wall degeneration related to bicuspid aortic valve anatomy in patients with valvular disease? J Thorac Cardiovasc Surg. 2008; 136: 937–942.
- 39Schnell S, Smith DA, Barker AJ, et al. Altered aortic shape in bicuspid aortic valve relatives influences blood flow patterns. Eur Heart J Cardiovasc Imaging. 2016; 17: 1239–1247.
- 40Ekici F, Uslu D, Bozkurt S. Elasticity of ascending aorta and left ventricular myocardial functions in children with bicuspid aortic valve. Echocardiography. 2017; 34: 1660–1666.
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