Association Between Bicuspid Aortic Valve Phenotype and Patterns of Valvular Dysfunction and Bicuspid Aortopathy Comprehensive Evaluation Using MDCT and Echocardiography
Association Between Bicuspid Aortic Valve Phenotype and Patterns of Valvular Dysfunction and Bicuspid Aortopathy Comprehensive Evaluation Using MDCT and Echocardiography
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DOI：
10.1016/j.jcmg.2012.11.007
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发表时间：
2013-02-01
影响因子：
14
通讯作者：
Song, Jae-Kwan
中科院分区：
文献类型：
--
作者：
Kang, Joon-Won;Song, Hae Geun;Song, Jae-Kwan
我们试图通过多探测器计算机断层扫描（MDCT）来确定二叶主动脉瓣（BAV）表型和二尖瓣病变综合分类的临床意义。背景BAV表型与瓣膜功能障碍或二叶主动脉瓣病变模式之间的相关性尚未明确确定。（116名男性，年龄54.6 ± 14.4岁），2003年至2010年接受MDCT和经胸超声心动图检查。两种BAV表型-右冠状动脉和左冠状动脉瓣的融合（BAV-AP）和右或左冠状动脉瓣和非冠状动脉瓣的融合（BAV-RL）被确定。45例患者显示正常的主动脉尺寸，并被归类为0型。在其余患者中，根据主动脉扩张模式，分层聚类分析显示3种不同类型的二尖瓣病变：1型（主动脉扩张局限于主动脉窦[n = 34]），2型（涉及升主动脉管状部分的主动脉扩张[n = 49]），结果BAV-AP和BAV-RL的患病率分别为55.7%和44.3%。比较BAV-AP和BAV-RL，没有确定年龄或男性患病率的差异。然而，瓣膜功能障碍模式存在显著差异，BAV-RL患者中中度至重度主动脉瓣狭窄占主导地位（BAV-AP中为66.2% vs. 46.2%; p = 0.01），BAV-AP中中度至重度主动脉瓣返流（BAV-RL中为32.3% vs. 6.8%; p < 0.0001）。正常主动脉是BAV-AP患者中最常见的表型（33.3% vs. 18.9%，BAV-RL; p = 0.037），3型脊椎病是BAV-RL患者中最常见的表型（BAV-AP组为40.5%vs9.7%;结论：两种BAV表型之间的瓣膜功能障碍和二尖瓣病变模式存在显著差异，提示可能存在病因学上不同的实体。（J Am科尔心脏病学杂志2013;6：150-61）（C）美国心脏病学会基金会2013年
OBJECTIVES We sought to define the clinical importance of an integrated classification of bicuspid aortic valve (BAV) phenotypes and aortopathy using multidetector computed tomography (MDCT).BACKGROUND An association between BAV phenotypes and the pattern of valvular dysfunction or bicuspid aortopathy has yet to be definitely established.METHODS The study cohort included 167 subjects (116 men, age 54.6 +/- 14.4 years) who underwent both MDCT and transthoracic echocardiography from 2003 to 2010. Two BAV phenotypes-fusion of the right and left coronary cusps (BAV-AP) and fusion of the right or left coronary cusp and noncoronary cusp (BAV-RL)-were identified. Forty-five patients showed normal aortic dimensions and were classified as type 0. In the remaining patients, hierarchic cluster analysis showed 3 different types of bicuspid aortopathy according to the pattern of aortic dilation: type 1 (aortic enlargement confined to the sinus of Valsalva [n = 34]), type 2 (aortic enlargement involving the tubular portion of the ascending aorta [n = 49]), and type 3 (aortic enlargement extending to the transverse aortic arch [n = 39]).RESULTS The prevalence of BAV-AP and BAV-RL was 55.7% and 44.3%, respectively. Comparing BAV-AP and BAV-RL, no differences in age or in the prevalence of male sex were determined. However, significant differences in the valvular dysfunction pattern were noted, with moderate-to-severe aortic stenosis predominating in patients with BAV-RL (66.2% vs. 46.2% in BAV-AP; p = 0.01), and moderate-to-severe aortic regurgitation in BAV-AP (32.3% vs. 6.8% in BAV-RL; p < 0.0001). A normal aorta was the most common phenotype in BAV-AP patients (33.3% vs. 18.9% in BAV-RL; p = 0.037), and type 3 aortopathy was the most common phenotype in BAV-RL patients (40.5% vs. 9.7% in BAV-AP; p < 0.0001).CONCLUSIONS The patterns of valvular dysfunction and bicuspid aortopathy differed significantly between the 2 BAV phenotypes, suggesting the possibility of etiologically different entities. (J Am Coll Cardiol Img 2013;6:150-61) (C) 2013 by the American College of Cardiology Foundation