Prevalence of coronary artery disease among patients with bicuspid aortic valve stenosis undergoing computed tomography before transcatheter aortic valve implantation

Introduction: A lower prevalence of coronary artery disease (CAD) was previously reported among bicuspid aortic valve (BAV) patients compared with tricuspid aortic valve (TAV) patients undergoing surgical aortic valve replacement. Unknown is the prevalence of CAD among BAV patients undergoing transcatheter aortic valve implantation (TAVI).

Methods: Consecutive BAV patients undergoing cardiac computed tomography angiography (CCTA) before TAVI were included. Studies with insufficient imaging quality were excluded. Forty-nine patients with history of prior percutaneous coronary intervention or coronary artery bypass graft surgery were also excluded. Coronary artery stenosis was categorized as ≤50% or >50% luminal diameter stenosis.

Results: One hundred and fourteen consecutive BAV patients were enrolled (age 72 ± 10.4 years, 64% males). BAV type 1A was the most common type (62%), followed by BAV type 0 (18%) and type 1C (10%). Cardiovascular risk factors were frequent: 23% (26) had history of diabetes mellitus, 45% (51) had dyslipidemia, 56% (64) had hypertension, and 25% (29) were current or past smokers. No correlation was found between calcium scoring of the aortic valve (3664.49 ± 1671.01 Agatston Units) and calcium scoring of the coronary arteries (410.51 ± 546.59 Agatston Units), correlation coefficient 0.43 (p=0.68). Obstructive coronary artery stenosis (> 50% luminal diameter stenosis) was observed among the minority (16%) of BAV patients. A single vessel disease was found in 7% of BAV patients, two vessels disease in 5% and triple vessels disease in 4%. Three BAV patients had a single vessel chronic total occlusion.

Conclusion: Among patients with BAV referred for TAVI, CCTA showed a low prevalence of obstructive coronary artery disease. The absence of correlation between aortic valve and coronary artery calcium scoring suggests the possibility of two heterogeneous aspects of the complex BAV disease.