Magnetic resonance analysis of ventricular volumes in bicuspid and trileaflet aortic regurgitation.

ABSTRACT

OBJECTIVE: To identify differences in left ventricular (LV) remodelling between patients with bicuspid aortic valve (BAV) and trileaflet aortic valve (TAV) with chronic aortic regurgitation (AR). METHODS: Retrospective cohort study of 210 consecutive patients undergoing cardiac magnetic resonance for AR evaluation. We divided the study population according to valvular morphology. Independent predictors of LV enlargement AR were evaluated. RESULTS: There were 110 patients with BAV and 100 patients with TAV. Patients with BAV were younger (mean age BAV vs TAV 41±16 years vs 67±11 years; p<0.01), mostly male (% male BAV vs TAV 84.5% vs 65%, p=0.01) and presented milder degrees of AR (median regurgitant fraction BAV vs TAV 14 (6-28)% vs 22 (12-35)%, p=0.002). Both groups presented similar indexed LV volumes and ejection fraction. According to the degree of AR, at mild AR, patients with BAV presented larger LV volumes (BAV vs TAV indexed end diastolic left ventricular volumes (iEDV) 96.5±19.7 vs 82.1±19.3 mL, p<0.01; indexed end systolic left ventricular volumes (iESV) 39.4±10.3 mL vs 33.2±10.5 mL, p=0.01). These differences disappeared at higher degrees of AR. Independent predictors of LV enlargement were regurgitant fraction (EDV OR 1.118 (1.081-1.156), p<0.001; ESV OR 1.067 (1.042-1.092), p<0.001), age (EDV OR 0.940 (0.917-0.964), p<0.001, ESV OR 0.962 (0.945-0.979), p<0.001) and weight (EDV OR 1.054 (1.025-1.083), p<0.001). CONCLUSIONS: In chronic AR, LV enlargement is an early finding. LV volumes display a direct correlation with regurgitant fraction and an inverse association with age. Patients with BAV present larger ventricular volumes, especially at mild AR. However, these differences are attributable to demographic disparities; valve type is not independently associated with LV size.