Aortic stiffness with bicuspid aortic valve is variable and not predicted by conventional parameters in young patients

Inter-rater reproducibility of PWV measurements was high (ICC= 0.97). There was no
significant difference in age between BAV and normal patients (28.1 ± 17.2 vs. 31.2
± 10.7 y, p=0.35). There was an overall trend toward higher PWV in patients with BAV
compared to normal patients (6.53 versus 3.51 m/s, p=0.11) with a considerably higher
standard deviation in BAV patients (SD of 5.88 versus 0.92 m/s)(Figure 1). No correlation was found between PWV and sex, BSA, aortic diameter, aortic valve
status, leaflet fusion pattern or history of coarctation repair in BAV patients. PWV
was mildly correlated with age (r=0.24, p=0.05) and history of hypertension (r=0.31,
p=0.02) in the overall BAV cohort, but these correlations did not persist in a subgroup
of patients 40 years old (n=37). When graphing PWV versus age, significantly different
slopes were noted between the ?40 and 40 year old subgroups by piecewise regression
(p0.01)(Figure 2). BAV patients with elevated PWV (6 m/s, n=10) did not demonstrate significant differences
in risk factors compared to those with normal PWV (6 m/s, n=27). In the 40 year
old subgroup, there were no statistically significant predictors of PWV identified
by multiple linear regression.

Figure 1. Histogram of PWV measurements. Bicuspid valve patients (A) displayed a larger range
of PWV values (1.3 – 25 m/s) compared to normal patients range (B) (3.0-5.3 m/s);
however, approximately two-thirds of bicuspid valve patients displayed PWV in the
normal range of 6 m/s (42/65, 64%).

Figure 2. Effect of age on peak wave velocity measurements. Significantly different slopes were
identified between patients 40 years old (blue dots) and those ?40 years old (red
dots) by piecewise regression with knot set at 40 years (p0.01s).