RESULTS
Prevalence of BAV . In this cohort of 48,503 unique patients aged ³ 18 years who underwent ECHO for any clinical indications, BAV was present in 0.51% (n=245 patients). Of all the BAV patients identified, 17.1% (N=41) patients presented in a Young age group, 58% (N=143) in the Middle age group, and 24.5% (N=64) in the Old age group.
Demographics and comorbidities . Male sex (65-72%) and Caucasian race (71.4-85%) were predominant across all age groups. Other races were more likely to present in younger age. BMI and BSA were higher in middle age compared to the older age group. In general, comorbidities corresponded with age except for stroke (19.5 % versus 7% versus 13.3%, P=.3159) and CHF (4.8% versus 7% versus 13.3%, P=0.2191) which were not different across the age groups. (Table 1)
Valvulopathy . Endocarditis (9.5% versus 2.8% versus 0%) and severe AI (11.9% versus 4.2% versus 0%) trended towards higher incidence in young age group with a statically significant difference between young and older age groups. Moderate AI and moderate AS were not different across the age groups. Severe AS was higher in middle and older age group but not statistically different from younger age group (0% vs 9.8% vs 10%, P=0.0991). Combined AV dysfunction was not statistically different across the age groups (0% vs 7% vs 3.3%, P=0.6056). (Table 2)
Aortopathy . Aortic root size (3.1 ± 0.6 cm versus 3.5 ± 0.6 cm versus 3.6 ± 0.6 cm, P<0.0001) and ascending aorta size (3.5 ± 0.8cm versus 4.0 ± 0.7cm versus 4.1 ± 0.6cm, P=0.0008) were higher in the middle and older age groups compared to the younger age group but there was no difference in the root or ascending aortic size between the middle and older age groups. (Table 2) Plotting the root/height index against age showed gradual increase with age that slows down or stops in the older age group. Similar pattern was seen when ascending aorta/height index was plotted against age. (Figures 1 and 2)
To define independent risk factors for TAA and dilatations, a multivariable logistic regression analysis was performed. The model included patient’s age, male sex, BSA, smoking, hypertension, hyperlipidemia, moderate or higher aortic valve stenosis, moderate or higher aortic valve insufficiency and left ventricular ejection fraction. Age (OR = 1.02 CI[1.00-1.04]) and BSA (OR = 7.31 [2.27-23.57]) were the only independent risk factors for TAA, while male sex, smoking, HTN, HLD, moderate or higher aortic valve stenosis, moderate or higher aortic valve insufficiency and left ventricular ejection fraction were not independent risk factors for TAA in this model. (Table 3)
Surgical intervention following diagnosis with BAV . 27% (N=66) had surgical intervention following ECHO diagnosis with BAV. 50% of the surgical intervention were aortic valve only. 12% of the patients had aortic (root or ascending) replacement only and 32% of patients had combined aorta and valve replacement. There was no statistically significant difference in the rates of intervention or types of intervention across age groups. (Table 2)