Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2016 May 18;5(5):e003200.
doi: 10.1161/JAHA.116.003200.

Impact of Valve Morphology on the Prevalence of Coronary Artery Disease: A Systematic Review and Meta-Analysis

Paolo Poggio  1 , Laura Cavallotti  2 , Paola Songia  3 , Alessandro Di Minno  4 , Pasquale Ambrosino  5 , Liborio Mammana  2 , Alessandro Parolari  6 , Francesco Alamanni  2 , Elena Tremoli  3 , Matteo Nicola Dario Di Minno  7
Affiliations
Meta-Analysis

Impact of Valve Morphology on the Prevalence of Coronary Artery Disease: A Systematic Review and Meta-Analysis

Paolo Poggio et al. J Am Heart Assoc. .

Abstract

Background: Literature studies suggested a lower prevalence of coronary artery disease (CAD) in bicuspid aortic valve (BAV) than in tricuspid aortic valve (TAV) patients. However, this finding has been challenged. We performed a meta-analysis to assess whether aortic valve morphology has a different association with CAD, concomitant coronary artery bypass grafting (CABG), and postoperative mortality.

Methods and results: Detailed search was conducted according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guideline to identify all patients with BAV or TAV and presence of CAD, concomitant myocardial surgical revascularization, and the postoperative mortality. Thirty-one studies on 3017 BAV and 4586 TAV patients undergoing aortic valve surgery were included. BAV patients showed a lower prevalence of CAD (odds ratio [OR]: 0.33; 95% CI: 0.17, 0.65), concomitant CABG (OR, 0.45; 95% CI: 0.35, 0.59), and postoperative mortality (OR, 0.62; 95% CI: 0.40, 0.97) than TAV. However, BAV subjects were significantly younger than TAV (mean difference: -7.29; 95% CI: -11.17, -3.41) were more frequently males (OR, 1.61; 95% CI: 1.33, 1.94) and exhibited a lower prevalence of hypertension (OR, 0.58; 95% CI: 0.39, 0.87) and diabetes (OR, 0.71; 95% CI: 0.54, 0.93). Interestingly, a metaregression analysis showed that younger age and lower prevalence of diabetes were associated with lower prevalence of CAD (Z value: -3.03; P=0.002 and Z value: -3.10; P=0.002, respectively) and CABG (Z value: -2.69; P=0.007 and Z value: -3.36; P=0.001, respectively) documented in BAV patients.

Conclusions: Analysis of raw data suggested an association of aortic valve morphology with prevalence of CAD, concomitant CABG, and postoperative mortality. Interestingly, the differences in age and diabetes have a profound impact on prevalence of CAD between BAV and TAV. In conclusion, our meta-analysis suggests that the presence of CAD is independent of aortic valve morphology.

Keywords: aortic valve morphology; bicuspid aortic valve; coronary artery disease.

PubMed Disclaimer

Figures

Figure 1
Figure 1
PRISMA flow diagram. BAV indicates bicuspid aortic valve; CT, computed tomography.
Figure 2
Figure 2
Prevalence of coronary artery disease in patients with bicuspid (BAV) and tricuspid aortic valve (TAV).
Figure 3
Figure 3
Prevalence of coronary artery bypass grafting (CABG) in patients with bicuspid (BAV) and tricuspid aortic valve (TAV).
Figure 4
Figure 4
Post‐operative mortality in patients with bicuspid (BAV) and tricuspid aortic valve (TAV).
Figure 5
Figure 5
Meta‐regression analysis. Effect of the difference in mean age (A) and in prevalence of diabetes (B) on prevalence of coronary artery disease in patients with bicuspid (BAV) and tricuspid aortic valve (TAV).
Figure 6
Figure 6
Meta‐regression analysis. Effect of the difference in mean age (A) and in prevalence of diabetes (B) on prevalence of concomitant coronary artery bypass grafting in patients with bicuspid (BAV) and tricuspid aortic valve (TAV).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez‐Sarano M. Burden of valvular heart diseases: a population‐based study. Lancet. 2006;368:1005–1011. - PubMed
    1. Osnabrugge RL, Mylotte D, Head SJ, Van Mieghem NM, Nkomo VT, LeReun CM, Bogers AJ, Piazza N, Kappetein AP. Aortic stenosis in the elderly: disease prevalence and number of candidates for transcatheter aortic valve replacement: a meta‐analysis and modeling study. J Am Coll Cardiol. 2013;62:1002–1012. - PubMed
    1. Pawade TA, Newby DE, Dweck MR. Calcification in aortic stenosis: the skeleton key. J Am Coll Cardiol. 2015;66:561–577. - PubMed
    1. Stewart BF, Siscovick D, Lind BK, Gardin JM, Gottdiener JS, Smith VE, Kitzman DW, Otto CM. Clinical factors associated with calcific aortic valve disease. Cardiovascular Health Study. J Am Coll Cardiol. 1997;29:630–634. - PubMed
    1. Patel DK, Green KD, Fudim M, Harrell FE, Wang TJ, Robbins MA. Racial differences in the prevalence of severe aortic stenosis. J Am Heart Assoc. 2014;3:e000879 doi: 10.1161/JAHA.114.000879. - DOI - PMC - PubMed