Background Transcatheter aortic valve replacement (TAVR) has been shown safe and feasible in patients with bicuspid aortic valve (BAV) morphology. Evaluation of inter-ethnic differences in valve morphology and function and aortic root dimensions in patients with BAV is important for the worldwide spread of this therapy in this subgroup of patients. Comparisons between large European and Asian cohorts of patients with BAV have not been performed, and potential differences between populations may have important implications for TAVR. Aim The present study evaluated the differences in valve morphology and function and aortic root dimensions between two large cohorts of European and Asian patients with BAV. Methods and results Aortic valve morphology was defined on transthoracic echocardiography according to the number of commissures and raphe: type 0 = no raphe and two commissures, type 1 = one raphe and two commissures, type 2 = two raphes and one commissure. Aortic stenosis and regurgitation were graded according to current recommendations. For this study, aortic root dimensions were manually measured on transthoracic echocardiograms at the level of the aortic annulus, sinus of Valsalva (SOV), sinotubular junction (STJ), and ascending aorta (AA). Of 1427 patients with BAV (45.2 ± 18.1 years, 71.9% men), 794 (55.6%) were Europeans and 633 (44.4%) were Asians. The groups were comparable in age and proportion of male sex. Asians had higher prevalence of type 1 BAV with raphe between right and non-coronary cusps than Europeans (19.7% vs. 13.6%, respectively; P < 0.001), whereas the Europeans had higher prevalence of type 0 BAV (two commissures, no raphe) than Asians (14.5% vs. 6.8%, respectively; P < 0.001). The prevalence of moderate and severe aortic regurgitation was higher in Europeans than Asians (44.2% vs. 26.8%, respectively; P < 0.001) whereas there were no differences in BAV with normal function or aortic stenosis. After adjusting for demographics, comorbidities, and valve function, the dimensions of the aortic annulus [mean difference 1.17 mm/m2, 95% confidence interval (CI) 0.96-1.39], SOV (mean difference 1.86 mm/m2, 95% CI 1.47-2.24), STJ (mean difference 0.52 mm/m2, 95% CI 0.14-0.90) and AA (mean difference 1.05 mm/m2, 95% CI 0.57-1.52) were significantly larger among Asians compared with Europeans. Conclusions This large multicentre registry reports for the first time that Asians with BAV showed more frequently type 1 BAV (with fusion between right and non-coronary cusp) and have larger aortic dimensions than Europeans. These findings have important implications for prosthesis type and size selection for TAVR.

中文翻译：

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亚洲和欧洲二叶主动脉瓣患者瓣膜形态、瓣膜功能障碍和主动脉病变的种族差异

背景 经导管主动脉瓣置换术 (TAVR) 在二叶主动脉瓣 (BAV) 形态的患者中已被证明是安全可行的。评估 BAV 患者瓣膜形态和功能以及主动脉根部尺寸的种族差异对于该治疗在该亚组患者中的全球传播很重要。尚未对欧洲和亚洲 BAV 患者的大型队列进行比较，人群之间的潜在差异可能对 TAVR 具有重要意义。目的 本研究评估了两个大型欧洲和亚洲 BAV 患者队列之间瓣膜形态和功能以及主动脉根部尺寸的差异。方法和结果 在经胸超声心动图上根据连合和中缝的数量定义主动脉瓣形态：类型 0 = 无中缝和两个连合处，类型 1 = 一个中缝和两个连合处，类型 2 = 两个中缝和一个连合处。根据当前的建议对主动脉瓣狭窄和反流进行分级。在这项研究中，主动脉根部尺寸在主动脉瓣环、瓦尔萨尔瓦窦 (SOV)、窦管交界处 (STJ) 和升主动脉 (AA) 水平的经胸超声心动图上手动测量。在 1427 名 BAV 患者（45.2 ± 18.1 岁，71.9% 男性）中，794 名（55.6%）是欧洲人，633 名（44.4%）是亚洲人。各组在年龄和男性比例方面具有可比性。与欧洲人相比，亚洲人右侧和非冠状动脉尖之间中缝的 1 型 BAV 患病率高于欧洲人（分别为 19.7% 和 13.6%；P < 0.001），而欧洲人的 0 型 BAV 患病率更高（两个连合，无中缝) 比亚洲人 (14.5% vs. 6.8%, 分别; P < 0.001)。欧洲人中度和重度主动脉瓣关闭不全的患病率高于亚洲人（分别为 44.2% 和 26.8%；P < 0.001），而功能正常或主动脉瓣狭窄的 BAV 没有差异。调整人口统计学、合并症和瓣膜功能后，主动脉瓣环的尺寸 [平均差异 1.17 mm/m2，95% 置信区间 (CI) 0.96-1.39]，SOV（平均差异 1.86 mm/m2，95% CI 1.47 -2.24)、STJ（平均差 0.52 mm/m2，95% CI 0.14-0.90）和 AA（平均差 1.05 mm/m2，95% CI 0.57-1.52）在亚洲人中明显高于欧洲人。结论 这项大型多中心注册首次报告称，亚洲人 BAV 显示出更频繁的 1 型 BAV（右侧和非冠状动脉瓣之间的融合）并且比欧洲人具有更大的主动脉尺寸。这些发现对 TAVR 的假体类型和尺寸选择具有重要意义。