Bicuspid Aortic Valve Is Associated with Less Coronary Calcium and Coronary Artery Disease Burden

Gudrun Feuchtner; Sven Bleckwenn; Leon Stoessl; Fabian Plank; Christoph Beyer; Nikolaos Bonaros; Thomas Schachner; Thomas Senoner; Gerlig Widmann; Can Gollmann-Tepeköylü; Johannes Holfeld; Wolfgang Dichtl; Fabian Barbieri

doi:10.3390/jcm10143070

Bicuspid Aortic Valve Is Associated with Less Coronary Calcium and Coronary Artery Disease Burden

J Clin Med. 2021 Jul 11;10(14):3070. doi: 10.3390/jcm10143070.

Affiliations

¹ Department Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria.
² Department Cardiac Surgery, Innsbruck Medical University, 6020 Innsbruck, Austria.
³ Department Internal Medicine III, Cardiology, Innsbruck Medical University, 6020 Innsbruck, Austria.
⁴ Department of Cardiology, Charite University Medicine, Campus Benjamin Franklin, 10117 Berlin, Germany.

Abstract

(1) Background. Bicuspid aortic valve (BAV) is associated with genetic defects (NOTCH 1, GATA 5) and aortopathy. Differences in the flow patterns and a genetic predisposition could also affect coronary arteries. The objective was to assess the coronary artery calcium score (CACS) and coronary artery disease (CAD) burden by coronary computed tomography angiography (CTA) in patients with BAV stenosis, as compared to stenotic tricuspid aortic valves (TAV). (2) Methods. A retrospective case-control study. A total of 47 patients with BAV stenosis (68.9 years ± 12.9, 38.3% females) who underwent CTA were matched with 47 TAV stenosis patients for age, gender, smoking, arterial hypertension, dyslipidemia, diabetes, body-mass-index and chronic kidney disease. (3) Results. The coronary artery calcium score (CACS) was lower in BAV (237.4 vs. 1013.3AU; p < 0.001) than in TAV, and stenosis severity was less (CAD-RAD^TM: p < 0.001). More patients with BAV had CACS zero (27.7% vs. 0%; p < 0.001). The majority (68.1%) of patients with BAV had no or non-obstructive CAD but only 25.5% of TAV (p < 0.001). Obstructive CAD (>50% stenosis) by CTA was more frequently observed in patients with TAV (68.1%; p < 0.001). (4) Conclusions and Relevance. Patients with BAV stenosis have markedly less coronary calcium and less severe coronary stenosis. CTA succeeds to rule out obstructive CAD in the majority of BAV, with adherent implications for TAVR planning.

Keywords: bicuspid aortic valve; computed tomography; coronary artery disease; coronary calcium.