Patel, Kush P;
Lin, Andrew;
Kumar, Niraj;
Esposito, Giulia;
Grodecki, Kajetan;
Lloyd, Guy;
Mathur, Anthony;
... Dey, Damini; + view all
(2023)
Influence of cusp morphology and sex on quantitative valve composition in severe aortic stenosis.
European Heart Journal - Cardiovascular Imaging
, 24
(12)
pp. 1653-1660.
10.1093/ehjci/jead142.
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Abstract
AIMS: Aortic stenosis is characterized by fibrosis and calcification of the valve, with a higher proportion of fibrosis observed in women. Stenotic bicuspid aortic valves progress more rapidly than tricuspid valves, which may also influence the relative composition of the valve. We aimed to investigate the influence of cusp morphology on quantitative aortic valve composition quantified from contrast-enhanced computed tomography angiography in severe aortic stenosis. METHODS AND RESULTS: Patients undergoing transcatheter aortic valve implantation with bicuspid and tricuspid valves were propensity matched 1:1 and results by age, sex, and comorbidities. Computed tomography angiograms were analysed using semi-automated software to quantify the fibrotic and calcific scores (volume/valve annular area) and the fibro-calcific ratio (fibrotic score/calcific score). The study population (n = 140) was elderly (76 ± 10 years, 62% male) and had a peak aortic jet velocity of 4.1 ± 0.7 m/s. Compared with those with tricuspid valves (n = 70), patients with bicuspid valves (n = 70) had higher fibrotic scores [204 (interquartile range 118–267) vs. 144 (99–208) mm3/cm2, P = 0.006] with similar calcific scores (P = 0.614). Women had greater fibrotic scores than men in bicuspid [224 (181–307) vs. 169 (109–247) mm3/cm2, P = 0.042] but not tricuspid valves (P = 0.232). Men had greater calcific scores than women in both bicuspid [203 (124–355) vs. 130 (70–182) mm3/cm2, P = 0.008] and tricuspid [177 (136–249) vs. 100 (62–150) mm3/cm2, P = 0.004] valves. Among both valve types, women had a greater fibro-calcific ratio compared with men [tricuspid 1.86 (0.94–2.56) vs. 0.86 (0.54–1.24), P = 0.001 and bicuspid 1.78 (1.21–2.90) vs. 0.74 (0.44–1.53), P = 0.001]. CONCLUSIONS: In severe aortic stenosis, bicuspid valves have proportionately more fibrosis than tricuspid valves, especially in women.
| Type: | Article |
|---|---|
| Title: | Influence of cusp morphology and sex on quantitative valve composition in severe aortic stenosis |
| Location: | England |
| Open access status: | An open access version is available from UCL Discovery |
| DOI: | 10.1093/ehjci/jead142 |
| Publisher version: | https://doi.org/10.1093/ehjci/jead142 |
| Language: | English |
| Additional information: | This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. |
| Keywords: | Aortic stenosis, bicuspid aortic valve, biology, fibrosis, calcification, sex |
| UCL classification: | UCL UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science |
| URI: | https://discovery-pp.ucl.ac.uk/id/eprint/10193823 |
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