Document Detail


Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community.
MedLine Citation:
PMID:  18506017     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Bicuspid aortic valve is frequent and is reported to cause numerous complications, but the clinical outcome of patients diagnosed with normal or mildly dysfunctional valve is undefined.
METHODS AND RESULTS: In 212 asymptomatic community residents from Olmsted County, Minn (age, 32+/-20 years; 65% male), bicuspid aortic valve was diagnosed between 1980 and 1999 with ejection fraction > or =50% and aortic regurgitation or stenosis, absent or mild. Aortic valve degeneration at diagnosis was scored echocardiographically for calcification, thickening, and mobility reduction (0 to 3 each), with scores ranging from 0 to 9. At diagnosis, ejection fraction was 63+/-5% and left ventricular diameter was 48+/-9 mm. Survival 20 years after diagnosis was 90+/-3%, identical to the general population (P=0.72). Twenty years after diagnosis, heart failure, new cardiac symptoms, and cardiovascular medical events occurred in 7+/-2%, 26+/-4%, and 33+/-5%, respectively. Twenty years after diagnosis, aortic valve surgery, ascending aortic surgery, or any cardiovascular surgery was required in 24+/-4%, 5+/-2%, and 27+/-4% at a younger age than the general population (P<0.0001). No aortic dissection occurred. Thus, cardiovascular medical or surgical events occurred in 42+/-5% 20 years after diagnosis. Independent predictors of cardiovascular events were age > or =50 years (risk ratio, 3.0; 95% confidence interval, 1.5 to 5.7; P<0.01) and valve degeneration at diagnosis (risk ratio, 2.4; 95% confidence interval, 1.2 to 4.5; P=0.016; >70% events at 20 years). Baseline ascending aorta > or =40 mm independently predicted surgery for aorta dilatation (risk ratio, 10.8; 95% confidence interval, 1.8 to 77.3; P<0.01).
CONCLUSIONS: In the community, asymptomatic patients with bicuspid aortic valve and no or minimal hemodynamic abnormality enjoy excellent long-term survival but incur frequent cardiovascular events, particularly with progressive valve dysfunction. Echocardiographic valve degeneration at diagnosis separates higher-risk patients who require regular assessment from lower-risk patients who require only episodic follow-up.
Authors:
Hector I Michelena; Valerie A Desjardins; Jean-François Avierinos; Antonio Russo; Vuyisile T Nkomo; Thoralf M Sundt; Patricia A Pellikka; A Jamil Tajik; Maurice Enriquez-Sarano
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  117     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2008 May 
Date Detail:
Created Date:  2008-05-28     Completed Date:  2008-06-30     Revised Date:  2010-12-17    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2776-84     Citation Subset:  AIM; IM    
Affiliation:
Divisions of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Aortic Valve / abnormalities*,  physiology*,  ultrasonography
Aortic Valve Insufficiency / mortality*,  physiopathology*,  surgery,  ultrasonography
Echocardiography, Doppler
Female
Follow-Up Studies
Heart Failure / mortality
Humans
Incidence
Longitudinal Studies
Male
Middle Aged
Minnesota / epidemiology
Predictive Value of Tests
Prospective Studies
Severity of Illness Index*
Stroke Volume
Survival Analysis
Grant Support
ID/Acronym/Agency:
R01 AR030582-43/AR/NIAMS NIH HHS
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