title: Sex Differences in Phenotypes of Bicuspid Aortic Valve and Aortopathy: Insights From a Large Multicenter, International Registry.
abstract: BACKGROUND
  This large multicenter, international bicuspid aortic valve (BAV) registry aimed to define the sex differences in prevalence, valve morphology, dysfunction (aortic stenosis/regurgitation), aortopathy, and complications (endocarditis and aortic dissection).
  
  
  RESULTS
  Demographic, clinical, and echocardiographic data at first presentation of 1992 patients with BAV (71.5% men) were retrospectively analyzed. BAV morphology and valve function were assessed; aortopathy configuration was defined as isolated dilatation of the sinus of Valsalva or sinotubular junction, isolated dilatation of the ascending aorta distal to the sinotubular junction, or diffuse dilatation of the aortic root and ascending aorta. New cases of endocarditis and aortic dissection were recorded. There were no significant sex differences regarding BAV morphology and frequency of normal valve function. When presenting with moderate/severe aortic valve dysfunction, men had more frequent aortic regurgitation than women (33.8% versus 22.2%,P<0.001), whereas women were more likely to have aortic stenosis (34.5% versus 44.1%,P<0.001). Men had more frequently isolated dilatation of the sinus of Valsalva or sinotubular junction (14.2% versus 6.7%,P<0.001) and diffuse dilatation of the aortic root and ascending aorta (16.2% versus 7.3%,P<0.001) than women. Endocarditis (4.5% versus 2.5%,P=0.037) and aortic dissections (0.5% versus 0%,P<0.001) occurred more frequently in men.
  
  
  CONCLUSIONS
  Although there is a male predominance among patients with BAV, men with BAV had more frequently moderate/severe aortic regurgitation at first presentation compared with women, whereas women presented more often with moderate/severe aortic stenosis compared with men. Furthermore, men had more frequent aortopathy than women.
authors.affiliation: From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.).
authors.forename: William K F
authors.initials: WK
authors.lastname: Kong
authors.affiliation: From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.).
authors.forename: Madelien V
authors.initials: MV
authors.lastname: Regeer
authors.affiliation: From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.).
authors.forename: Arnold C T
authors.initials: AC
authors.lastname: Ng
authors.affiliation: From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.).
authors.forename: Louise
authors.initials: L
authors.lastname: McCormack
authors.affiliation: From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.).
authors.forename: Kian Keong
authors.initials: KK
authors.lastname: Poh
authors.affiliation: From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.).
authors.forename: Tiong Cheng
authors.initials: TC
authors.lastname: Yeo
authors.affiliation: From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.).
authors.forename: Miriam
authors.initials: M
authors.lastname: Shanks
authors.affiliation: From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.).
authors.forename: Sarah
authors.initials: S
authors.lastname: Parent
authors.affiliation: From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.).
authors.forename: Roxana
authors.initials: R
authors.lastname: Enache
authors.affiliation: From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.).
authors.forename: Bogdan A
authors.initials: BA
authors.lastname: Popescu
authors.affiliation: From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.).
authors.forename: James W
authors.initials: JW
authors.lastname: Yip
authors.affiliation: From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.).
authors.forename: Lawrence
authors.initials: L
authors.lastname: Ma
authors.affiliation: From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.).
authors.forename: Vasileios
authors.initials: V
authors.lastname: Kamperidis
authors.affiliation: From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.).
authors.forename: Enno T
authors.initials: ET
authors.lastname: van der Velde
authors.affiliation: From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.).
authors.forename: Bart
authors.initials: B
authors.lastname: Mertens
authors.affiliation: From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.).
authors.forename: Nina
authors.initials: N
authors.lastname: Ajmone Marsan
authors.affiliation: From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.).
authors.forename: Victoria
authors.initials: V
authors.lastname: Delgado
authors.affiliation: From the Department of Cardiology (W.K.F.K., M.V.R., V.K., E.T.v.d.V., N.A.M., V.D., J.J.B.) and Medical Statistics Department (B.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, National University Heart Centre, National University Health System, Singapore (W.K.F.K., K.K.P., T.C.Y., J.W.Y.); Department of Cardiology, Princess Alexandra Hospital, The University of Queensland, St Lucia, Australia (A.C.T.N., L.M.C., L.M.); Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada (M.S., S.P.); University of Medicine and Pharmacy "Carol Davila", Department of Cardiology-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania (R.E., B.A.P.); and Department of Cardiology, AHEPA University Hospital, Thessaloniki, Greece (V.K.). j.j.bax@lumc.nl.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D001021:Aortic Valve / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D001315:Australia / Q000453:epidemiology; D000082882:Bicuspid Aortic Valve Disease; D002170:Canada / Q000453:epidemiology; D004452:Echocardiography; D004696:Endocarditis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D005060:Europe / Q000453:epidemiology; D005260:Female; D054624:Health Status Disparities; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D015995:Prevalence; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors
keywords: aortic disease; aortic valve stenosis; bicuspid aortic valve; endocarditis