SPC365

Beta-blockers: a modifier of the natural history of bicuspid aortic valves?

Session: Comunicações Orais (Sessão 24) - Cardiopatias Congénitas, Doença Vascular Pulmonar e Embolia Pulmonar 2 - Foco no Adulto com Cardiopatia Congénita
Speaker: Sara Couto Pereira

Congress: CPC 2022
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 20. Congenital Heart Disease and Pediatric Cardiology
Subtheme: 20.4 Congenital Heart Disease – Treatment
Session Type: Comunicações Orais
FP Number: ---
Authors: Sara Couto Pereira; Joana Rigueira; Pedro Silvério António; Joana Brito; Beatriz Valente Silva; Pedro Alves da Silva; Afonso Nunes-Ferreira; Catarina Simões de Oliveira; Ana Margarida Martins; Cláudio David; Fausto j. Pinto; Ana g. Almeida

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="color:black">Introduction: </span></strong><span style="color:black">Bicuspid aortic valve (BAV) disease is one of the most common congenital heart diseases, with an incidence of 0.5&ndash;2.0%. In BAV disease, aortic dilatation (AD) is frequent and the use of beta-blockers (BB) and angiotensin receptor blockers (ARB) are expected to slow ascending aorta dilation. In BAV patients (pts) the rule of BB an ARB to prevent AD is not established.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="color:black">Purpose:&nbsp;</span></strong><span style="color:black">T</span><span style="color:black">o characterize a population of BAV pts and evaluate the impact of BB and ARB to prevent AD.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="color:black">Methods:&nbsp;</span></strong><span style="color:black">Single-center retrospective study of consecutive pts </span><span style="color:black">with isolated BAV documented on the laboratory center echocardiography from 2014 to 2020. Baseline demographic, clinic (including baseline therapy) and echocardiography data were collected. Follow-up (FUP) data of aortic surgery and death were registered. For statistical analysis we performed Chi-Square, Mann-Whitney, Cox regression and survival analysis with Kaplan-Maier curves. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="color:black">Results:&nbsp;</span></strong><span style="color:black">We included 250 pts with BAV (mean age 53 &plusmn; 15 years, 70.8% males), 148 pts (59.2%) with type 1 Sievers classification, 61 pts (24.4%) with type 2, 9 pts (3.6%) with type 3. Clinical characteristics were similar between groups. At baseline, 114 (45.6%) had AD (root, ascending aorta or both). We observed that BAV type 1 was associated with higher rates of aortic valvopathy: more pts with severe aortic regurgitation (total n= 31; 80.6% type 1 vs 19.4% type 2, p=0.030) and severe aortic stenosis (total n=43; 55.8% type 1 vs 37.2% type 2, p=0.042). On the other hand, we didn&rsquo;t find any association regarding the phenotype of BAV and presence of AD (p=NS). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="color:black">During a mean FUP of 5.6&plusmn;5.3 years, from 136 pts without previously documented AD, 52 pts (38.2%) developed this complication. At baseline, 46 (34.6%) were under BB and 20 (15%) pts under ARB, while the remaining had no medication. We found that BB therapy was a protective factor for AD during the FUP (LogRank: 4.052, p=0.044), but ARB therapy was not (p=NS).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="color:black">Mortality at FUP occurred in 32 pts (15.2%, more frequent in type 1, n=15) with no differences according to phenotypes, AD or valvopathy.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="color:black">Conclusions: </span></strong><span style="color:black">The natural history of BAV seems worst in BAV type 1 with more valvopathy, but with no differences in terms of mortality.</span><span style="color:black"> BB therapy seems protective of AD in previous non-dilated aorta in BAV pts. We hypothesize that in BAV pts therapy with BB when started before AD could prevent this complication. A larger study is needed to validate our findings.</span></span></span></span></p>