Background:Differences in adverse cardiac remodeling between patients who have bicuspid (BAV) and tricuspid aortic valve (TAV) with severe isolated aortic stenosis (AS) and its prognostic impact after surgical aortic valve replacement remains unclear. We sought to investigate differences in preoperative diastolic and systolic function in patients with BAV and TAV who have severe isolated AS and the incidence of postoperative heart failure hospitalization and mortality.Methods:Two hundred seventy-one patients with BAV (n=152) or TAV (n=119) and severe isolated AS without coronary artery disease or other valvular heart disease, scheduled for surgical aortic valve replacement, were prospectively included. Comprehensive preoperative echocardiographic assessment of left ventricular (LV) diastolic and systolic function was performed. The heart failure events were registered during a mean prospective follow-up of 1260 days versus 1441 days for patients with BAV or TAV, respectively.Results:Patients with BAV had a more pronounced LV hypertrophy with significantly higher indexed LV mass ([LVMi] 134 g/m² versus 104 g/m², P<0.001), higher prevalence of LV diastolic dysfunction (72% versus 44%, P<0.001), reduced LV ejection fraction (55% versus 60%, P<0.001), significantly impaired global longitudinal strain (P<0.001), significantly higher NT-proBNP (N-terminal pro-brain natriuretic peptide) levels (P=0.007), and a higher prevalence of preoperative levosimendan treatment (P<0.001) than patients with TAV. LVMi was associated with diastolic dysfunction in both patients with BAV and TAV. There was a significant interaction between aortic valve morphology and LVMi on LV ejection fraction, which indicated a pronounced association between LVMi and LV ejection fraction for patients with BAV and lack of association between LVMi and LV ejection fraction for patients with TAV. Postoperatively, the patients with BAV required significantly more inotropic support (P<0.001). The patients with BAV had a higher cumulative incidence of postoperative heart failure admissions compared with patients with TAV (28.2% versus 10.6% at 6 years after aortic valve replacement, log-rank P=0.004). Survival was not different between patients with BAV and TAV (log-rank P=0.165).Conclusions:Although they were significantly younger, patients with BAV who had isolated severe AS had worse preoperative LV function and an increased risk of postoperative heart failure hospitalization compared with patients who had TAV. Our findings suggest that patients who have BAV with AS might benefit from closer surveillance and possibly earlier intervention.

中文翻译：

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二尖瓣主动脉瓣狭窄患者在手术前表现出不利的左心室重构和心脏功能受损，术后心力衰竭的风险增加

背景：二尖瓣 (BAV) 和三尖瓣主动脉瓣 (TAV) 合并严重孤立性主动脉瓣狭窄 (AS) 的患者在不良心脏重塑方面的差异及其对手术主动脉瓣置换术后的预后影响仍不清楚。我们试图调查患有严重孤立性 AS 的 BAV 和 TAV 患者术前舒张和收缩功能的差异以及术后心力衰竭住院和死亡率的发生率。方法：271 名 BAV 或 TAV 患者（n=152）前瞻性纳入（n=119）和没有冠状动脉疾病或其他瓣膜性心脏病的严重孤立性 AS，计划进行外科主动脉瓣置换术。对左心室 (LV) 舒张和收缩功能进行了全面的术前超声心动图评估。²与 104 g/m ²，P <0.001），左室舒张功能障碍的患病率较高（72% 对 44%，P <0.001），左室射血分数降低（55% 对 60%，P <0.001），全球显着受损纵向应变（P <0.001），NT-proBNP（N端脑钠肽前体）水平显着升高（P = 0.007），术前左西孟旦治疗的患病率更高（P<0.001) 比 TAV 患者。LVMi 与 BAV 和 TAV 患者的舒张功能障碍有关。主动脉瓣形态和 LVMi 对 LV 射血分数有显着的相互作用，这表明 BAV 患者的 LVMi 和 LV 射血分数之间存在显着关联，而 TAV 患者的 LVMi 和 LV 射血分数之间缺乏关联。术后，BAV 患者需要明显更多的正性肌力支持（P <0.001）。与 TAV 患者相比，BAV 患者术后心衰入院的累积发生率更高（主动脉瓣置换术后 6 年分别为 28.2% 和 10.6%，对数秩P = 0.004）。BAV 和 TAV 患者的生存率没有差异（对数秩P= 0.165). 结论：与患有 TAV 的患者相比，孤立的严重 AS 的 BAV 患者虽然更年轻，但其术前左室功能更差，术后心衰住院风险增加。我们的研究结果表明，患有 BAV 的 AS 患者可能会受益于更密切的监测和可能的早期干预。