TY - JOUR
T1 - Influence of cusp morphology and sex on quantitative valve composition in severe aortic stenosis
AU - Patel, Kush P.
AU - Lin, Andrew
AU - Kumar, Niraj
AU - Esposito, Giulia
AU - Grodecki, Kajetan
AU - Lloyd, Guy
AU - Mathur, Anthony
AU - Baumbach, Andreas
AU - Mullen, Michael J.
AU - Williams, Michelle C.
AU - Newby, David E.
AU - Treibel, Thomas A.
AU - Dweck, Marc R.
AU - Dey, Damini
N1 - Funding Information:
Conflict of interest: K.P.P. and M.J.M. have received an unrestricted grant from Edwards Lifesciences. K.G. reports grants or contracts from the Foundation for Polish Science and Polish Society of Cardiology. D.D. received software royalties from Cedars-Sinai Medical Center outside of the current work and holds a patent (US8885905B2/WO2011069120A1, Method and System for Plaque Characterisation). M.C.W. reports a grant from the British Heart Foundation; declares payment or honoraria from Cannon Medical Systems; and reports leadership or fiduciary roles with the British Society of Cardiovascular Imaging, Society of Cardiovascular Computed Tomography, and European Society of Cardiovascular Radiology. M.R.D. reports consulting fees from Novartis, Jupiter Bioventures, and Silence Therapeutics and payment or honoraria from Pfizer and Novartis. D.E.N. reports a grant from the British Heart Foundation and Wellcome Trust.
Publisher Copyright:
© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved.
PY - 2023/12
Y1 - 2023/12
N2 - 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 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.
AB - 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 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.
KW - aortic stenosis
KW - bicuspid aortic valve
KW - biology
KW - calcification
KW - fibrosis
KW - sex
UR - http://www.scopus.com/inward/record.url?scp=85178497509&partnerID=8YFLogxK
U2 - 10.1093/ehjci/jead142
DO - 10.1093/ehjci/jead142
M3 - Article
C2 - 37339331
AN - SCOPUS:85178497509
SN - 2047-2404
VL - 24
SP - 1653
EP - 1660
JO - European Heart Journal - Cardiovascular Imaging
JF - European Heart Journal - Cardiovascular Imaging
IS - 12
ER -