Challenges of recognizing bicuspid aortic valve in elderly patients undergoing TAVR.
Recognition of bicuspid aortic valve (BAV) may be challenging in elderly patients with heavily calcified aortic valves undergoing transcatheter aortic valve replacement (TAVR). In this subset, the diagnostic value of pre-procedural echocardiography in clinical routine is unknown. From a total of 2583 patients undergoing TAVR in our center, we determined the rate of BAV detected by routine echocardiography as documented in the medical records. Pre-procedural multidetector computed tomography (MDCT) images were retrospectively analyzed for the presence of BAV and served as reference standard. Using MDCT criteria, BAV was found in 235 (9.1%) (age 80.1 years [interquartile range 76.4; 83.4], 44.3% female). Of these, only 27/235 (11.5%) had been identified as BAV according to echocardiography reports, whereas 6/2348 (0.3%) with TAV had been wrongly diagnosed as BAV (p < 0.001; sensitivity 11.5%, specificity 99.7%). Correct diagnosis of BAV by echocardiography was more likely when transesophageal echocardiography was available (odds ratio (OR) 5.12 [95% confidence interval (CI) 2.22; 11.80]; p < 0.001) and the reader was experienced (OR 5.28 [95% CI 1.55; 18.04]; p = 0.008). Furthermore, correct diagnosis of BAV was more likely in bicommissural-type BAV (OR 2.22 [95% CI 0.90; 5.48]; p = 0.08), whereas heavy aortic valve calcification lead to misdiagnosis (OR 0.39 [95% CI 0.14; 1.06]; p = 0.07). In elderly patients with severe aortic stenosis that are candidates for TAVR, the presence of BAV may be considerably underestimated when relying solely on routine echocardiography. This underlines the value of MDCT for the screening of BAV in this patient population.
['Kim|Won-Keun|WK|http://orcid.org/0000-0002-0799-7478', 'Liebetrau|Christoph|C|', 'Fischer-Rasokat|Ulrich|U|', 'Renker|Matthias|M|', 'Rolf|Andreas|A|', 'Doss|Mirko|M|', 'Möllmann|Helge|H|', 'Nef|Holger|H|', 'Walther|Thomas|T|', 'Hamm|Christian W|CW|']
D000367:Age Factors D000368:Aged D000369:Aged, 80 and over D001021:Aortic Valve D001024:Aortic Valve Stenosis D000082882:Bicuspid Aortic Valve Disease D002114:Calcinosis D004452:Echocardiography D005260:Female D006349:Heart Valve Diseases D006801:Humans D008297:Male D061330:Multidetector Computed Tomography D064847:Multimodal Imaging D011237:Predictive Value of Tests D015203:Reproducibility of Results D012189:Retrospective Studies D012720:Severity of Illness Index D065467:Transcatheter Aortic Valve Replacement
Bicuspid aortic valve TAVR Echocardiography MDCT Aortic stenosis