| Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community. | |
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MedLine Citation:
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PMID: 18506017 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article |
Journal Detail:
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Title: Circulation Volume: 117 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2008 May |
Date Detail:
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Created Date: 2008-05-28 Completed Date: 2008-06-30 Revised Date: 2010-12-17 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 2776-84 Citation Subset: AIM; IM |
Affiliation:
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Divisions of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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:
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R01 AR030582-43/AR/NIAMS NIH HHS |
| Comments/Corrections | |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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