title: Predictors of rapid aortic dilatation in adults with a bicuspid aortic valve.
abstract: OBJECTIVE
  The role of atherosclerosis and atherosclerotic risk factors in predicting progressive aortic dilatation in patients with bicuspid aortic valve (BAV) is not well defined. The study aim was to assess the role of these risk factors in progressive aortic dilatation in patients with this condition.
  
  
  METHODS
  Adult patients were identified with BAV who displayed rapid aortic dilatation, and the association of the condition with hemodynamic and atherosclerotic risk factors was assessed. By using the Dartmouth-Hitchcock and Hartford Hospital echocardiographic databases between 1997 and 2009, a total of 135 patients with BAV and serial echocardiograms recorded at least one year apart were allocated to groups of rapid progressors (RP; n = 53) or slow progressors (SP; n = 82). Rapid aortic progression was defined as an annual rate of progression > or = 75th percentile at the sinus of Valsalva or ascending aorta level. Univariate atherosclerotic and hemodynamic variables that correlated with rapid aortic dilatation were analyzed, and independent predictors of rapid aortic dilatation identified.
  
  
  RESULTS
  The RP group had higher mean random blood glucose levels, greater coronary artery disease, more tobacco use, and a higher National Heart, Lung and Blood Institute 10-year risk of developing coronary heart disease (10-year risk). An elevated 10-year risk of > 7% (OR 4.5; 95% CI 1.92-10.73), tobacco use (OR 5.05; 95% CI 1.51-16.86) and higher random blood glucose level (OR 1.01; 95% CI 1.002-1.03) were independent predictors of rapid aortic dilatation.
  
  
  CONCLUSIONS
  In adults with BAV and non-dilated aortas at baseline, an elevated 10-year risk, tobacco use and hyperglycemia may serve as predictors of rapid aortic dilatation.
authors.affiliation: Section of Cardiology, Department of Medicine, Hartford Hospital, Hartford, CT, USA. Ali.F.Iqtidar@Lahey.Org
authors.forename: Ali F
authors.initials: AF
authors.lastname: Iqtidar
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: O'Rourke
authors.forename: David I
authors.initials: DI
authors.lastname: Silverman
authors.forename: Paul D
authors.initials: PD
authors.lastname: Thompson
authors.forename: Anthony W
authors.initials: AW
authors.lastname: DiScipio
authors.forename: Robert T
authors.initials: RT
authors.lastname: Palac
mesh_terms: D000328:Adult; D000368:Aged; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology; D016009:Chi-Square Distribution; D003237:Connecticut; D004108:Dilatation, Pathologic; D018450:Disease Progression; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D006943:Hyperglycemia / Q000150:complications; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009513:New Hampshire; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012850:Sinus of Valsalva / Q000000981:diagnostic imaging / Q000503:physiopathology; D012907:Smoking / Q000009:adverse effects; D013997:Time Factors; D014463:Ultrasonography