Sex-specific patterns of valvulo-aortopathy in bicuspid aortic valve according to the international consensus framework: insights from the RE-BAV registry

@article{plonskagosciniak2026sexspecific,
  title = {{Sex-specific patterns of valvulo-aortopathy in bicuspid aortic valve according to the international consensus framework: insights from the RE-BAV registry}},
  author = {Edyta Płońska-Gościniak and Wojciech Kosmala and Jerzy Pacholewicz and Celina Wojciechowska and Ilona Kowalik and Bożena Sobkowicz and Tomasz Hirnle and Andrzej Tomaszewski and Beata Zaborska and Maria Binkiewicz-Orluk and Andrzej Szyszka and Tomasz Hryniewiecki and Julia Grapsa and Frank A Flachskampf and Rafał Dankowski},
  journal = {European Heart Journal Cardiovascular Imaging},
  year = {2026},
  month = aug,
  doi = {10.1093/ehjci/jeag233},
  url = {https://doi.org/10.1093/ehjci/jeag233},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Sex-specific patterns of valvulo-aortopathy in bicuspid aortic valve according to the international consensus framework: insights from the RE-BAV registry
AU  - Edyta Płońska-Gościniak
AU  - Wojciech Kosmala
AU  - Jerzy Pacholewicz
AU  - Celina Wojciechowska
AU  - Ilona Kowalik
AU  - Bożena Sobkowicz
AU  - Tomasz Hirnle
AU  - Andrzej Tomaszewski
AU  - Beata Zaborska
AU  - Maria Binkiewicz-Orluk
AU  - Andrzej Szyszka
AU  - Tomasz Hryniewiecki
AU  - Julia Grapsa
AU  - Frank A Flachskampf
AU  - Rafał Dankowski
PY  - 2026
DA  - 2026/08/31
JO  - European Heart Journal Cardiovascular Imaging
DO  - 10.1093/ehjci/jeag233
UR  - https://doi.org/10.1093/ehjci/jeag233
AB  - Aims: To characterize sex-specific patterns of bicuspid aortic valve (BAV) valvulo-aortopathy using consensus phenotyping and to assess how aortic normalization strategies influence sex-related differences in aortic dimensions.  Methods and results: We analysed 808 adults with BAV (mean age 49.9 ± 17.5 years; 588 men) from the RE-BAV registry. Valve morphology, aortopathy phenotypes, and clinical valvulo-aortopathy categories were classified according to consensus definitions. Typical and uncomplicated forms were additionally analysed together as a non-complex category. Proximal aortic dimensions were defined as the aortic root and ascending aorta.  Valve morphology distribution did not differ by sex. Although the prevalence of aortic dilatation was similar, phenotype distribution differed: women more frequently exhibited the extended phenotype (34.7% vs. 23.3%, P = 0.001), whereas the root phenotype was more common in men (15.1% vs. 7.8%, P = 0.006). Moderate-to-severe aortic regurgitation was more prevalent in men (50.3% vs. 29.1%, P < 0.001). Sex differences in proximal aortic dimensions varied by normalization strategy. For the ascending aorta, indexing to body surface area yielded larger values in women (21.1 ± 4.0 vs. 20.0 ± 4.0 mm/m², P = 0.001), whereas diameter/height showed no sex-related difference at this level. Conversely, the cross-sectional area-to-height ratio remained higher in men across proximal segments, most prominently at the sinuses of Valsalva (6.9 ± 2.0 vs. 5.6 ± 1.6 cm²/m, P < 0.001). Age was independently associated with larger proximal aortic dimensions across all strategies.  Conclusion: Sex-related differences in BAV involved aortopathy phenotype, aortic regurgitation burden, and proximal aortic dimensions. Interpretation of proximal aortic dimensions depended on the normalization strategy used, indicating that indexing methods should not be treated as interchangeable.
SN  - 2047-2404
SN  - 2047-2412
ER  -