Blood and Imaging Biomarkers in the Long-term Follow-up of Bicuspid Aortic Valve Patients

Zoë A. Keuning; Paul M. Hendriks; Anthonie L. Duijnhouwer; Frederike Meccanici; Hans Marc J. Siebelink; Allard T. van den Hoven; Laurie W. Geenen; Jannet A. Eindhoven; Vivan J.M. Baggen; Judith A.A.E. Cuypers; Robert M. Kauling; Jolien W. Roos-Hesselink; Annemien E. van den Bosch

doi:10.1016/j.cjco.2023.09.012

Blood and Imaging Biomarkers in the Long-term Follow-up of Bicuspid Aortic Valve Patients

Zoë A. Keuning
, Paul M. Hendriks
, Anthonie L. Duijnhouwer
, Frederike Meccanici
, Hans Marc J. Siebelink
, Allard T. van den Hoven
, Laurie W. Geenen
, Jannet A. Eindhoven
, Vivan J.M. Baggen
, Judith A.A.E. Cuypers
, Robert M. Kauling
, Jolien W. Roos-Hesselink^*
, Annemien E. van den Bosch^*

^*Corresponding author for this work

Cardiology

Leiden University Medical Centre
Radboud University Medical Center
European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)

Research output: Contribution to journal › Article › Academic › peer-review

4 Citations (Scopus)

42 Downloads (Pure)

Abstract

Background:

Bicuspid aortic valve (BAV) is a common congenital heart defect. Patients with BAV are at risk for long-term complications such as valve stenosis and regurgitation. This study aimed to investigate sex differences in blood and imaging biomarkers and to describe the long-term prognostic value of blood and echocardiographic biomarkers.

Methods:

Patients were included from 2 prospective observational cohort studies; they underwent venous blood sampling and transthoracic echocardiography including speckle tracking. Analyzed blood biomarkers were red-cell distribution width (RDW), creatinine, C-reactive protein (CRP), troponin T, N-terminal pro B-type natriuretic peptide (NT-proBNP), and transforming growth factor-beta (TGF-β). Sex differences were analyzed at baseline. Associations between biomarkers and arrhythmia-free and intervention-free survival were determined by Cox regression, adjusted for age and sex.

Results:

A total of 182 patients with BAV were included: median age 34; interquartile range [IQR]: 23-46 years; 55.5% male. CRP, NT-proBNP, and RDW were higher in women, whereas creatinine, troponin T and TGF-β were higher among men. After a median follow-up time of 6.9 (IQR: 6.5-9.9) years, arrhythmia-free and intervention-free survival was, 81.0% and 73.1%, respectively. NT-proBNP was associated with both arrhythmia-free and intervention-free survival (hazard ratio [HR], 1.94, P = 0.005 and HR, 2.06, P = 0.002, respectively). On echocardiography higher left atrial (LA) size, left ventricular end-diastolic diameter (LVEDD), left ventricular (LV) mass index and E/e’ ratio were associated with lower arrhythmia-free survival, whereas higher LA size, LV mass index, aortic valve peak velocity, and aortic regurgitation were associated with lower intervention-free survival.

Conclusions:

Differences were observed in blood biomarkers between men and women with BAV. Besides LV systolic parameters, diastolic LV function and NT-proBNP should have a more prominent role as prognostic markers in clinical care.

Original language	English
Pages (from-to)	1-10
Number of pages	10
Journal	CJC Open
Volume	6
Issue number	1
Early online date	23 Sept 2023
DOIs	https://doi.org/10.1016/j.cjco.2023.09.012
Publication status	Published - Jan 2024

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Publisher Copyright:
© 2023 The Authors

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Keuning, Z. A., Hendriks, P. M., Duijnhouwer, A. L., Meccanici, F., Siebelink, H. M. J., van den Hoven, A. T., Geenen, L. W., Eindhoven, J. A., Baggen, V. J. M., Cuypers, J. A. A. E., Kauling, R. M., Roos-Hesselink, J. W., & van den Bosch, A. E. (2024). Blood and Imaging Biomarkers in the Long-term Follow-up of Bicuspid Aortic Valve Patients. CJC Open, 6(1), 1-10. https://doi.org/10.1016/j.cjco.2023.09.012

@article{b9260833213d4bb7bd7397e5d94e5487,

title = "Blood and Imaging Biomarkers in the Long-term Follow-up of Bicuspid Aortic Valve Patients",

abstract = "Background: Bicuspid aortic valve (BAV) is a common congenital heart defect. Patients with BAV are at risk for long-term complications such as valve stenosis and regurgitation. This study aimed to investigate sex differences in blood and imaging biomarkers and to describe the long-term prognostic value of blood and echocardiographic biomarkers. Methods:Patients were included from 2 prospective observational cohort studies; they underwent venous blood sampling and transthoracic echocardiography including speckle tracking. Analyzed blood biomarkers were red-cell distribution width (RDW), creatinine, C-reactive protein (CRP), troponin T, N-terminal pro B-type natriuretic peptide (NT-proBNP), and transforming growth factor-beta (TGF-β). Sex differences were analyzed at baseline. Associations between biomarkers and arrhythmia-free and intervention-free survival were determined by Cox regression, adjusted for age and sex. Results:A total of 182 patients with BAV were included: median age 34; interquartile range [IQR]: 23-46 years; 55.5\% male. CRP, NT-proBNP, and RDW were higher in women, whereas creatinine, troponin T and TGF-β were higher among men. After a median follow-up time of 6.9 (IQR: 6.5-9.9) years, arrhythmia-free and intervention-free survival was, 81.0\% and 73.1\%, respectively. NT-proBNP was associated with both arrhythmia-free and intervention-free survival (hazard ratio [HR], 1.94, P = 0.005 and HR, 2.06, P = 0.002, respectively). On echocardiography higher left atrial (LA) size, left ventricular end-diastolic diameter (LVEDD), left ventricular (LV) mass index and E/e{\textquoteright} ratio were associated with lower arrhythmia-free survival, whereas higher LA size, LV mass index, aortic valve peak velocity, and aortic regurgitation were associated with lower intervention-free survival. Conclusions: Differences were observed in blood biomarkers between men and women with BAV. Besides LV systolic parameters, diastolic LV function and NT-proBNP should have a more prominent role as prognostic markers in clinical care.",

author = "Keuning, \{Zo{\"e} A.\} and Hendriks, \{Paul M.\} and Duijnhouwer, \{Anthonie L.\} and Frederike Meccanici and Siebelink, \{Hans Marc J.\} and \{van den Hoven\}, \{Allard T.\} and Geenen, \{Laurie W.\} and Eindhoven, \{Jannet A.\} and Baggen, \{Vivan J.M.\} and Cuypers, \{Judith A.A.E.\} and Kauling, \{Robert M.\} and Roos-Hesselink, \{Jolien W.\} and \{van den Bosch\}, \{Annemien E.\}",

note = "Publisher Copyright: {\textcopyright} 2023 The Authors",

year = "2024",

month = jan,

doi = "10.1016/j.cjco.2023.09.012",

language = "English",

volume = "6",

pages = "1--10",

journal = "CJC Open",

issn = "2589-790X",

publisher = "Elsevier Inc.",

number = "1",

}

Keuning, ZA, Hendriks, PM, Duijnhouwer, AL, Meccanici, F, Siebelink, HMJ, van den Hoven, AT, Geenen, LW, Eindhoven, JA, Baggen, VJM , Cuypers, JAAE , Kauling, RM , Roos-Hesselink, JW & van den Bosch, AE 2024, 'Blood and Imaging Biomarkers in the Long-term Follow-up of Bicuspid Aortic Valve Patients', CJC Open, vol. 6, no. 1, pp. 1-10. https://doi.org/10.1016/j.cjco.2023.09.012

TY - JOUR

T1 - Blood and Imaging Biomarkers in the Long-term Follow-up of Bicuspid Aortic Valve Patients

AU - Keuning, Zoë A.

AU - Hendriks, Paul M.

AU - Duijnhouwer, Anthonie L.

AU - Meccanici, Frederike

AU - Siebelink, Hans Marc J.

AU - van den Hoven, Allard T.

AU - Geenen, Laurie W.

AU - Eindhoven, Jannet A.

AU - Baggen, Vivan J.M.

AU - Cuypers, Judith A.A.E.

AU - Kauling, Robert M.

AU - Roos-Hesselink, Jolien W.

AU - van den Bosch, Annemien E.

PY - 2024/1

Y1 - 2024/1

N2 - Background: Bicuspid aortic valve (BAV) is a common congenital heart defect. Patients with BAV are at risk for long-term complications such as valve stenosis and regurgitation. This study aimed to investigate sex differences in blood and imaging biomarkers and to describe the long-term prognostic value of blood and echocardiographic biomarkers. Methods:Patients were included from 2 prospective observational cohort studies; they underwent venous blood sampling and transthoracic echocardiography including speckle tracking. Analyzed blood biomarkers were red-cell distribution width (RDW), creatinine, C-reactive protein (CRP), troponin T, N-terminal pro B-type natriuretic peptide (NT-proBNP), and transforming growth factor-beta (TGF-β). Sex differences were analyzed at baseline. Associations between biomarkers and arrhythmia-free and intervention-free survival were determined by Cox regression, adjusted for age and sex. Results:A total of 182 patients with BAV were included: median age 34; interquartile range [IQR]: 23-46 years; 55.5% male. CRP, NT-proBNP, and RDW were higher in women, whereas creatinine, troponin T and TGF-β were higher among men. After a median follow-up time of 6.9 (IQR: 6.5-9.9) years, arrhythmia-free and intervention-free survival was, 81.0% and 73.1%, respectively. NT-proBNP was associated with both arrhythmia-free and intervention-free survival (hazard ratio [HR], 1.94, P = 0.005 and HR, 2.06, P = 0.002, respectively). On echocardiography higher left atrial (LA) size, left ventricular end-diastolic diameter (LVEDD), left ventricular (LV) mass index and E/e’ ratio were associated with lower arrhythmia-free survival, whereas higher LA size, LV mass index, aortic valve peak velocity, and aortic regurgitation were associated with lower intervention-free survival. Conclusions: Differences were observed in blood biomarkers between men and women with BAV. Besides LV systolic parameters, diastolic LV function and NT-proBNP should have a more prominent role as prognostic markers in clinical care.

AB - Background: Bicuspid aortic valve (BAV) is a common congenital heart defect. Patients with BAV are at risk for long-term complications such as valve stenosis and regurgitation. This study aimed to investigate sex differences in blood and imaging biomarkers and to describe the long-term prognostic value of blood and echocardiographic biomarkers. Methods:Patients were included from 2 prospective observational cohort studies; they underwent venous blood sampling and transthoracic echocardiography including speckle tracking. Analyzed blood biomarkers were red-cell distribution width (RDW), creatinine, C-reactive protein (CRP), troponin T, N-terminal pro B-type natriuretic peptide (NT-proBNP), and transforming growth factor-beta (TGF-β). Sex differences were analyzed at baseline. Associations between biomarkers and arrhythmia-free and intervention-free survival were determined by Cox regression, adjusted for age and sex. Results:A total of 182 patients with BAV were included: median age 34; interquartile range [IQR]: 23-46 years; 55.5% male. CRP, NT-proBNP, and RDW were higher in women, whereas creatinine, troponin T and TGF-β were higher among men. After a median follow-up time of 6.9 (IQR: 6.5-9.9) years, arrhythmia-free and intervention-free survival was, 81.0% and 73.1%, respectively. NT-proBNP was associated with both arrhythmia-free and intervention-free survival (hazard ratio [HR], 1.94, P = 0.005 and HR, 2.06, P = 0.002, respectively). On echocardiography higher left atrial (LA) size, left ventricular end-diastolic diameter (LVEDD), left ventricular (LV) mass index and E/e’ ratio were associated with lower arrhythmia-free survival, whereas higher LA size, LV mass index, aortic valve peak velocity, and aortic regurgitation were associated with lower intervention-free survival. Conclusions: Differences were observed in blood biomarkers between men and women with BAV. Besides LV systolic parameters, diastolic LV function and NT-proBNP should have a more prominent role as prognostic markers in clinical care.

UR - https://www.scopus.com/pages/publications/85181245584

U2 - 10.1016/j.cjco.2023.09.012

DO - 10.1016/j.cjco.2023.09.012

M3 - Article

C2 - 38313345

AN - SCOPUS:85181245584

SN - 2589-790X

VL - 6

SP - 1

EP - 10

JO - CJC Open

JF - CJC Open

IS - 1

ER -

Blood and Imaging Biomarkers in the Long-term Follow-up of Bicuspid Aortic Valve Patients

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