Bicuspid Aortic Valve: Inter-Racial Difference in Frequency and Aortic Dimensions

OBJECTIVES The objective of this study was to examine the similarities and differences in Caucasian (C) and African-American (AA) patients with bicuspid aortic valve (BAV) with respect to morphology, severity of aortic stenosis/insufficiency, and aortic dilation. BACKGROUND BAV is a common congenital valve abnormality, accounting for a large number of valve replacements. METHODS A total of 229 patients with the diagnostic code BAV were identified retrospectively from our computerized adult echocardiographic database, which consists of 91,896 studies performed at the University of Chicago Medical Center from 1998 to 2009, representing 40,878 patients. Of those, 183 patients with BAV were included in this retrospective BAV single-center cohort study and reanalyzed with a comprehensive assessment of aortic dimensions, aortic valve morphology and function, clinical cardiovascular risk factors, and patient characteristics. RESULTS Of the 183 patients with BAV, 138 were C and 45 were AA. Our echocardiographic database encompasses approximately 65% AA, 31% C, and 4% other races, for an estimated frequency of BAV in AA patients of 0.17% and a frequency in C patients of 1.1% (p = 0.001). There were no significant inter-racial differences regarding sex, height, weight, hyperlipidemia, diabetes, tobacco use, cardiac medications, and left ventricular ejection fraction. The AA cohort was older (age 50 +/- 17 years vs. 43 +/- 17 years, p < 0.05) and had a higher prevalence of hypertension (51% vs. 24%, p < 0.05). After adjusting for comorbidities, aortic dimensions were larger in C (C vs. AA: annulus, 2.4 +/- 0.4 vs. 2.1 +/- 0.4 cm; sinuses of Valsalva, 3.4 +/- 0.7 vs. 3.1 +/- 0.6 cm; sinotubular junction, 3.0 +/- 0.6 vs. 2.6 +/- 0.5 cm; and ascending aorta, 3.5 +/- 0.7 vs. 3.2 +/- 0.5 cm; all p values < 0.05). CONCLUSIONS This is the first study to report racial differences among patients with BAV with reduced aortic dimensions in AA patients despite the presence of more risk factors, suggestive of marked heterogeneity in the BAV population and indicating race as a potential disease modifier in BAV. (J Am Coll Cardiol Img 2012;5:981-9) (C) 2012 by the American College of Cardiology Foundation