Clinical research studyPredictors of Ascending Aortic Dilation in Bicuspid Aortic Valve Disease: A Five-year Prospective Study
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Materials and Methods
This study was approved by the institutional review board of the University of Massachusetts Medical School. Between 2003 and 2008, 115 asymptomatic subjects with the echocardiographic diagnosis of bicuspid aortic valve and no prior cardiac surgery were recruited at the University of Massachusetts Medical School. Subjects gave written informed consent and underwent baseline and yearly echocardiography for 5 years. Clinical information was obtained from patient interviews at the time of
Results
Of the 115 subjects originally enrolled, 18 were excluded because of aortic valve replacement within 3 years of enrollment and 7 were excluded for <3 years of follow-up data (lost to follow-up). Ninety subjects had 3 to 5 years of follow-up data and no prior aortic valve replacement. Of these 90 subjects, 6 had subsequent valve replacements after enrollment, but had at least 3 annual echocardiograms before surgery and were included in the analysis. The interobserver reliability for measurement
Discussion
The large number of studies published in recent years on the subject of aortic dilation in patients with bicuspid aortic valves attests to the growing awareness of and interest in predicting aortic complications in these patients. The 2008 guidelines for surgical repair of aortic dilation with bicuspid aortic valves include an aortic diameter of >5 cm or diameter >4.5 cm and a yearly dilation rate >0.5 cm/y.11 Other indications include aortic diameter >4 cm in a patient undergoing elective
Conclusions
We found that among asymptomatic subjects with bicuspid aortic valves, studied prospectively, there was an annual rate of ascending aortic dilation of 0.47 mm/y, consistent with rates previously described.3, 12, 14 Given the prospective design of our study in a predefined population of asymptomatic patients with bicuspid aortic valves, these results are perhaps more generalizable within this population than those of previous retrospective reports, which may have associated biases. The majority
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Funding: Supported in part by a grant from the Department of Medicine at the University of Massachusetts Medical School.
Conflict of Interest: None.
Authorship: All authors had access to the data and played a role in writing this manuscript.