Link: http://jama.jamanetwork.com/article.aspx?articleid=1104327
Among BAV population, aneurysms very common, dissections not so...
Some excerpts from the paper, a population study(416 BAV patients):
To our knowledge, this study reports for the first time the BAV incidence of aortic dissection in a population-based setting, using a community cohort with definite BAV diagnosis and comprehensive methods to assess aortic events in undiagnosed BAV in the population.
The low aortic dissection incidence and lack of association with a detectable reduction in survival is reassuring. Due to purported similarities between BAV and Marfan aortas, aortic outcomes in BAV have been assumed as equivalent to Marfan.Although BAV aortopathy may share biological similarities with Marfan syndrome and aneurysms are common in both conditions, our study provides evidence that their clinical outcome is not comparable because aortic dissection is a major cardiovascular criterion for Marfan syndrome and patients with Marfan syndrome who have not undergone surgery have poor survival, with aortic complications being responsible for 80% of cardiac deaths.
The retrospective community cohort study design that we used constitutes the only feasible method to address our aims. Although all patients with BAV seen at the Mayo Clinic would provide a larger sample, a cohort of all community patients with documented definite BAV has the advantage of eliminating many referral biases that have plagued previous BAV studies.
Design, Setting, and Participants: In this retrospective cohort study, we conducted comprehensive assessment of aortic complications of patients with BAV living in a population-based setting in Olmsted County, Minnesota. We analyzed long-term follow-up of a cohort of all Olmsted County residents diagnosed with definite BAV by echocardiography from 1980 to 1999 and searched for aortic complications of patients whose bicuspid valves had gone undiagnosed. The last year of follow-up was 2008-2009.
Results: The cohort included 416 consecutive patients with definite BAV diagnosed by echocardiography, mean (SD) follow-up of 16 (7) years (6530 patient-years). Aortic dissection occurred in 2 of 416 patients; incidence of 3.1 (95% CI, 0.5-9.5) cases per 10 000 patient-years, age-adjusted relative-risk 8.4 (95% CI, 2.1-33.5; P = .003) compared with the county's general population. Aortic dissection incidences for patients 50 years or older at baseline and bearers of aortic aneurysms at baseline were 17.4 (95% CI, 2.9-53.6) and 44.9 (95% CI, 7.5-138.5) cases per 10 000 patient-years, respectively. Comprehensive search for aortic dissections in undiagnosed bicuspid valves revealed 2 additional patients, allowing estimation of aortic dissection incidence in bicuspid valve patients irrespective of diagnosis status (1.5; 95% CI, 0.4-3.8 cases per 10 000 patient-years), which was similar to the diagnosed cohort. Of 384 patients without baseline aneurysms, 49 developed aneurysms at follow-up, incidence of 84.9 (95% CI, 63.3-110.9) cases per 10 000 patient-years and an age-adjusted relative risk 86.2 (95% CI, 65.1-114; P <.001 compared with the general population). The 25-year rate of aortic surgery was 25% (95% CI, 17.2%-32.8%).
Conclusions: In the population of patients with BAV, the incidence of aortic dissection over a mean of 16 years of follow-up was low but significantly higher than in the general population.
___________________
Another publication from a prominent center in Toronto (Canada) where a large population (642 BAV patients) is monitored at one place:
http://www.ncbi.nlm.nih.gov/pubmed/18799444
Among BAV population, aneurysms very common, dissections not so...
Some excerpts from the paper, a population study(416 BAV patients):
To our knowledge, this study reports for the first time the BAV incidence of aortic dissection in a population-based setting, using a community cohort with definite BAV diagnosis and comprehensive methods to assess aortic events in undiagnosed BAV in the population.
The low aortic dissection incidence and lack of association with a detectable reduction in survival is reassuring. Due to purported similarities between BAV and Marfan aortas, aortic outcomes in BAV have been assumed as equivalent to Marfan.Although BAV aortopathy may share biological similarities with Marfan syndrome and aneurysms are common in both conditions, our study provides evidence that their clinical outcome is not comparable because aortic dissection is a major cardiovascular criterion for Marfan syndrome and patients with Marfan syndrome who have not undergone surgery have poor survival, with aortic complications being responsible for 80% of cardiac deaths.
The retrospective community cohort study design that we used constitutes the only feasible method to address our aims. Although all patients with BAV seen at the Mayo Clinic would provide a larger sample, a cohort of all community patients with documented definite BAV has the advantage of eliminating many referral biases that have plagued previous BAV studies.
Design, Setting, and Participants: In this retrospective cohort study, we conducted comprehensive assessment of aortic complications of patients with BAV living in a population-based setting in Olmsted County, Minnesota. We analyzed long-term follow-up of a cohort of all Olmsted County residents diagnosed with definite BAV by echocardiography from 1980 to 1999 and searched for aortic complications of patients whose bicuspid valves had gone undiagnosed. The last year of follow-up was 2008-2009.
Results: The cohort included 416 consecutive patients with definite BAV diagnosed by echocardiography, mean (SD) follow-up of 16 (7) years (6530 patient-years). Aortic dissection occurred in 2 of 416 patients; incidence of 3.1 (95% CI, 0.5-9.5) cases per 10 000 patient-years, age-adjusted relative-risk 8.4 (95% CI, 2.1-33.5; P = .003) compared with the county's general population. Aortic dissection incidences for patients 50 years or older at baseline and bearers of aortic aneurysms at baseline were 17.4 (95% CI, 2.9-53.6) and 44.9 (95% CI, 7.5-138.5) cases per 10 000 patient-years, respectively. Comprehensive search for aortic dissections in undiagnosed bicuspid valves revealed 2 additional patients, allowing estimation of aortic dissection incidence in bicuspid valve patients irrespective of diagnosis status (1.5; 95% CI, 0.4-3.8 cases per 10 000 patient-years), which was similar to the diagnosed cohort. Of 384 patients without baseline aneurysms, 49 developed aneurysms at follow-up, incidence of 84.9 (95% CI, 63.3-110.9) cases per 10 000 patient-years and an age-adjusted relative risk 86.2 (95% CI, 65.1-114; P <.001 compared with the general population). The 25-year rate of aortic surgery was 25% (95% CI, 17.2%-32.8%).
Conclusions: In the population of patients with BAV, the incidence of aortic dissection over a mean of 16 years of follow-up was low but significantly higher than in the general population.
___________________
Another publication from a prominent center in Toronto (Canada) where a large population (642 BAV patients) is monitored at one place:
http://www.ncbi.nlm.nih.gov/pubmed/18799444
