Ascending aortic size in aortic coarctation depends on aortic valve morphology: Understanding the bicuspid valve phenotype

Research output: Research - peer-reviewArticle

Abstract

Background In roughly half of patients with coarctation of the aorta (CoA), the aorta may be enlarged. It is uncertain whether enlargement is independent of aortic valve morphology. We sought to compare aortic size in CoA with a tricuspid valve (TAV) to those with bicuspid aortic valve (BAV). Methods Sixty-eight CoA patients and 20 healthy controls with prior cardiac magnetic resonance (CMR) imaging were included. CMR was retrospectively reanalyzed to measure aortic root and mid-ascending aorta. The maximum aortic diameter was compared between CoA with TAV, CoA with BAV, and control groups. Results CoA with TAV patients (n = 27) had smaller aortic root diameters than CoA with BAV (n = 41) (32 ± 4.9 vs. 37 ± 5.8 mm, p = 0.001), despite being older (40 vs. 32 years, p = 0.01). Similarly, TAV CoA patients had a smaller mid-ascending aortic diameter (28 ± 4.5 vs. 33 ± 6.9 mm, p = 0.019) than BAV patients. TAV CoA was similar to controls in all metrics. Twenty-four patients (35%) with CoA had dilated aortas (> 37 mm), of which 79% had BAV. A history of hypertension did not predict larger aortic root or mid-ascending aortic dimensions. Conclusions In patients with CoA, TAV is associated with smaller aortic size compared to those with BAV, and similar to healthy controls. Aortic size in CoA is independent of hypertension. Therefore, aortopathy associated with BAV is likely a reflection of the BAV phenotype rather than CoA or its physiologic effects. This distinction may have implications for the frequency and types of monitoring and treatment of CoA patients.

LanguageEnglish (US)
Pages106-109
Number of pages4
JournalInternational Journal of Cardiology
Volume250
DOIs
StatePublished - Jan 1 2018

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Aortic Coarctation
Aortic Valve
Mitral Valve
Phenotype
Bicuspid Aortic Valve
Aorta
Hypertension
Tricuspid Valve
Magnetic Resonance Spectroscopy
Magnetic Resonance Imaging
Control Groups
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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title = "Ascending aortic size in aortic coarctation depends on aortic valve morphology: Understanding the bicuspid valve phenotype",
abstract = "Background In roughly half of patients with coarctation of the aorta (CoA), the aorta may be enlarged. It is uncertain whether enlargement is independent of aortic valve morphology. We sought to compare aortic size in CoA with a tricuspid valve (TAV) to those with bicuspid aortic valve (BAV). Methods Sixty-eight CoA patients and 20 healthy controls with prior cardiac magnetic resonance (CMR) imaging were included. CMR was retrospectively reanalyzed to measure aortic root and mid-ascending aorta. The maximum aortic diameter was compared between CoA with TAV, CoA with BAV, and control groups. Results CoA with TAV patients (n = 27) had smaller aortic root diameters than CoA with BAV (n = 41) (32 ± 4.9 vs. 37 ± 5.8 mm, p = 0.001), despite being older (40 vs. 32 years, p = 0.01). Similarly, TAV CoA patients had a smaller mid-ascending aortic diameter (28 ± 4.5 vs. 33 ± 6.9 mm, p = 0.019) than BAV patients. TAV CoA was similar to controls in all metrics. Twenty-four patients (35%) with CoA had dilated aortas (> 37 mm), of which 79% had BAV. A history of hypertension did not predict larger aortic root or mid-ascending aortic dimensions. Conclusions In patients with CoA, TAV is associated with smaller aortic size compared to those with BAV, and similar to healthy controls. Aortic size in CoA is independent of hypertension. Therefore, aortopathy associated with BAV is likely a reflection of the BAV phenotype rather than CoA or its physiologic effects. This distinction may have implications for the frequency and types of monitoring and treatment of CoA patients.",
author = "Frandsen, {Erik L.} and Burchill, {Luke J.} and Khan, {Abigail M.} and Broberg, {Craig S.}",
year = "2018",
month = "1",
doi = "10.1016/j.ijcard.2017.07.017",
volume = "250",
pages = "106--109",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier Ireland Ltd",

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TY - JOUR

T1 - Ascending aortic size in aortic coarctation depends on aortic valve morphology

T2 - International Journal of Cardiology

AU - Frandsen,Erik L.

AU - Burchill,Luke J.

AU - Khan,Abigail M.

AU - Broberg,Craig S.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background In roughly half of patients with coarctation of the aorta (CoA), the aorta may be enlarged. It is uncertain whether enlargement is independent of aortic valve morphology. We sought to compare aortic size in CoA with a tricuspid valve (TAV) to those with bicuspid aortic valve (BAV). Methods Sixty-eight CoA patients and 20 healthy controls with prior cardiac magnetic resonance (CMR) imaging were included. CMR was retrospectively reanalyzed to measure aortic root and mid-ascending aorta. The maximum aortic diameter was compared between CoA with TAV, CoA with BAV, and control groups. Results CoA with TAV patients (n = 27) had smaller aortic root diameters than CoA with BAV (n = 41) (32 ± 4.9 vs. 37 ± 5.8 mm, p = 0.001), despite being older (40 vs. 32 years, p = 0.01). Similarly, TAV CoA patients had a smaller mid-ascending aortic diameter (28 ± 4.5 vs. 33 ± 6.9 mm, p = 0.019) than BAV patients. TAV CoA was similar to controls in all metrics. Twenty-four patients (35%) with CoA had dilated aortas (> 37 mm), of which 79% had BAV. A history of hypertension did not predict larger aortic root or mid-ascending aortic dimensions. Conclusions In patients with CoA, TAV is associated with smaller aortic size compared to those with BAV, and similar to healthy controls. Aortic size in CoA is independent of hypertension. Therefore, aortopathy associated with BAV is likely a reflection of the BAV phenotype rather than CoA or its physiologic effects. This distinction may have implications for the frequency and types of monitoring and treatment of CoA patients.

AB - Background In roughly half of patients with coarctation of the aorta (CoA), the aorta may be enlarged. It is uncertain whether enlargement is independent of aortic valve morphology. We sought to compare aortic size in CoA with a tricuspid valve (TAV) to those with bicuspid aortic valve (BAV). Methods Sixty-eight CoA patients and 20 healthy controls with prior cardiac magnetic resonance (CMR) imaging were included. CMR was retrospectively reanalyzed to measure aortic root and mid-ascending aorta. The maximum aortic diameter was compared between CoA with TAV, CoA with BAV, and control groups. Results CoA with TAV patients (n = 27) had smaller aortic root diameters than CoA with BAV (n = 41) (32 ± 4.9 vs. 37 ± 5.8 mm, p = 0.001), despite being older (40 vs. 32 years, p = 0.01). Similarly, TAV CoA patients had a smaller mid-ascending aortic diameter (28 ± 4.5 vs. 33 ± 6.9 mm, p = 0.019) than BAV patients. TAV CoA was similar to controls in all metrics. Twenty-four patients (35%) with CoA had dilated aortas (> 37 mm), of which 79% had BAV. A history of hypertension did not predict larger aortic root or mid-ascending aortic dimensions. Conclusions In patients with CoA, TAV is associated with smaller aortic size compared to those with BAV, and similar to healthy controls. Aortic size in CoA is independent of hypertension. Therefore, aortopathy associated with BAV is likely a reflection of the BAV phenotype rather than CoA or its physiologic effects. This distinction may have implications for the frequency and types of monitoring and treatment of CoA patients.

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