Diagnostic Pathway and Clinical Significance of Premature Ventricular Beats (PVBs) in Trained Bicuspid Aortic Valve (BAV) Athletes

Purpose: Bicuspid aortic valve (BAV) represents a common congenital cardiac disease (1–2%) normally compatible with sports activity. In the case of competitive sports, eligibility can be barred by the presence of symptoms, aortic valve dysfunction, or arrhythmias. This investigation of a large cohort of BAV athletes aims to verify the prevalence of premature ventricular beats (PVBs) found in the exercise test (ET) at the first sports medicine clinical evaluation. Methods: A sample of 356 BAV athletes, regularly examined over a period of 10 years at the Sports Medicine Center of the University of Florence, was retrospectively evaluated for arrhythmic events found in the first sports medicine check-up carried out. The athletes (321 M and 79 F), aged between 8–50 years (mean age 21.8 ± 11.6), practised sports at high dynamic cardiovascular intensity (mainly soccer, basketball, and athletics). Criteria for participation included a 2D echocardiography and ET conducted at 85% of maximal effort. Ventricular arrhythmic events were reported if found to be ≥3 at rest and/or during the exercise test and for subjects with any other cardiac or systemic structural diseases. Individuals aged >50 were excluded from the study. The selected participants were matched with a control group of 400 athletes with similar levels of training (age 20.0 ± 9.9) without BAV. Results: Only 25 (7.02%) of BAV athletes showed PVBs at the ET. A total of 403 single PVBs and four monomorphic couples were observed; a polymorphic pattern was present in only three athletes, and only five had exercise-induced PVBs at peak. None had acute events or major arrhythmias. The difference in PVBs prevalence in BAV athletes vs. controls (PVBs 6.25%) was not significant (p > 0.05). Conclusions: The prevalence of PVBs is low in BAV athletes and appears not to differ from athletes without BAV. Despite this, the behaviour of PVBs at the ET should be considered for the major suspicion for arrhythmic events. More data in this field could optimize the cost/effectiveness ratio for eventual ECG Holter indications.

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Bicuspid Aortic Valve and Sports Activity

Encyclopedia of Cardiovascular Research and Medicine ◽

10.1016/b978-0-12-809657-4.99706-0 ◽

2018 ◽

pp. 263-272

Author(s):

L. Stefani ◽

G. Galanti ◽

N. Maffulli

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Sports Activity

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ALTERATION OF ELASTIC PROPERTIES IN CONGENITAL/INHERITED AORTIC DISEASES: MRI STUDY IN MARFAN SYNDROME AND BICUSPID AORTIC VALVE

Journal of Mechanics in Medicine and Biology ◽

10.1142/s0219519406001807 ◽

2006 ◽

Vol 06 (01) ◽

pp. 47-53

Author(s):

LUIGI LOVATO ◽

PAOLO SBARZAGLIA ◽

SILVIA MAGI ◽

VINCENZO RUSSO ◽

ROMANO ZANNOLI ◽

...

Keyword(s):

Aortic Valve ◽

Marfan Syndrome ◽

Elastic Properties ◽

Bicuspid Aortic Valve ◽

Aortic Distensibility ◽

Control Group ◽

Aortic Dilation ◽

Aortic Diseases ◽

Magnetic Resonance Imaging Mri ◽

Mri Study

Marfan Syndrome and Bicuspid Aortic Valve (BAV) are characterized by the congenital/inherited alteration of the fibrillin proteins of aortic wall extracellular matrix, with higher incidence of aortic dissection/rupture even without aortic dilation. Therefore, early identification and treatment of aortic involvement could improve prognosis. The purpose of this study was to evaluate aortic elastic properties of BAV and Marfan Syndrome patients to identify an index of early aortic involvement. Methods: A Magnetic Resonance Imaging (MRI) study was performed on 38 BAV patients, 20 Marfan patients and 14 healthy volunteers as a control group. A high-resolution gradient-echo sequence was applied in the axial plane at the level of pulmonary artery bifurcation to evaluate aortic distensibility. Results: Aortic distensibility was significantly different among the three groups (ANOVA, p = 0.0001) and was sensibly reduced in BAV (0.0056 ± 0.0048 versus 0.025 ± 0.006 control group) and Marfan (0.0085 ± 0.006 versus 0.025 ± 0.006 control group). Intraobserver and interobserver reproducibility for diastolic measurements were 1.2% and 0.4% respectively and for systolic measurements, they were 1.1% and 0.3% respectively. Conclusion: In BAV or Marfan Syndrome patients, MRI evaluation of abnormal distensibility may provide a reliable index of early aortic involvement, even before aortic dilation occurs.

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Continuous Compression as an Effective Therapeutic Intervention in Treating Eccentric-Exercise-Induced Muscle Soreness

Journal of Sport Rehabilitation ◽

10.1123/jsr.10.1.11 ◽

2001 ◽

Vol 10 (1) ◽

pp. 11-23 ◽

Cited By ~ 55

Author(s):

William J. Kraemer ◽

Jill A. Bush ◽

Robbin B. Wickham ◽

Craig R. Denegar ◽

Ana L. Gomez ◽

...

Keyword(s):

Eccentric Exercise ◽

Sports Medicine ◽

Muscle Soreness ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Force Production ◽

Elbow Flexion ◽

Control Group ◽

Arm Circumference ◽

Exercise Induced

Context:Prior investigations using ice, massage, or exercise have not shown efficacy in relieving delayed-onset muscle soreness.Objectives:To determine whether a compression sleeve worn immediately after maximal eccentric exercise enhances recovery.Design:Randomized, controlled clinical study.Setting:University sports medicine laboratory.Participants:Fifteen healthy, non-strength-trained men, matched for physical criteria, randomly placed in a control group or a continuous compression-sleeve group (CS).Methods and Measures:Subjects performed 2 sets of 50 arm curls. 1RM elbow flexion at 60°/s, upper-arm circumference, resting-elbow angle, serum creatine kinase (CK), and perception-of-soreness data were collected before exercise and for 3 days.Results:CK was significantly (P< .05) elevated from the baseline value in both groups, although the elevation in the CS group was less. CS prevented loss of elbow extension, decreased subjects’ perception of soreness, reduced swelling, and promoted recovery of force production.Conclusions:Compression is important in soft-tissue-injury management.

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Prevalence of bicuspid aortic valve in patients with aneurysmal sub-arachnoid hemorrhage: neurologic features and outcomes

European Heart Journal ◽

10.1093/eurheartj/ehab724.2742 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

S Vallabhajosyula ◽

L T Yang ◽

M Enriquez-Sarano ◽

A Rabinstein ◽

H Michelena

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Final Analysis ◽

Control Group ◽

World Federation ◽

Neurologic Outcomes ◽

Routine Surveillance ◽

Increased Risk ◽

Group 5 ◽

Arachnoid Hemorrhage

Abstract Background Intracranial aneurysm (IA) has been associated with bicuspid aortic valve (BAV) with prevalence of 6–10% which has led some to recommend routine surveillance for IA in BAV patients. Higher incidence of IA in BAV could signal towards systemic arteriopathy beyond the thoracic aorta. With CoA as an independent risk factor for IA formation, it is currently uncertain if the association between IA and BAV reflects the association of BAV and CoA, or the result of BAV-related systemic arterial changes. Purpose Despite this association, 2 small studies suggest no increased risk of the most important patient outcome: aneurysmal sub-arachnoid hemorrhage (aSAH). Our primary aim was identifying the prevalence of BAV in aSAH patients and compare it with that of a control group without aSAH. Secondary aims included neurologic outcomes of aSAH and anatomical characteristics of IA in BAV, and final disposition and outcome. Methods Patients (>18 years age) with an accurate diagnosis of aSAH and at least one echocardiogram in the system between January 2000-December 2019 were identified from a prospectively maintained registry of aSAH admissions. Controls, without a diagnosis of SAH ever, were age- and gender-matched (1:2 cases:controls). BAV prevalence was echocardiographically-confirmed in all patients. Severity of aSAH was categorized using the modified Fisher (mFisher) and the World Federation of Neurological Scale (WFNS). Results A total of 488 aSAH cases and 990 controls were included in the final analysis with confirmed aortic valve status. The prevalence of BAV in aSAH patients was 1.2% (6/488) vs 3.5% (35/990) in controls, p=0.01. None of the aSAH cases were noted to have CoA, whereas 3 (0.3%; p=0.12) control patients had presence of both BAV and CoA. Within aSAH patients, BAV+aSAH were noted to be younger than tricuspid aortic valve (TAV)+aSAH (56±11 vs 68±14; p=0.03). Aneurysm size was smaller in the BAV+aSAH group (5±2 vs 7±4 in TAV+aSAH; p=0.31). The severity of the bleed was lesser in BAV+aSAH than TAV+aSAH (mFisher grade >2 50% vs 74%; p=0.19, WFNS grade >3 17% vs 36%; p=0.43) which is clinically significant. The BAV+aSAH group had higher disposition rate to home (67% vs 39%; p=0.21) with no difference in in-hospital mortality rates (17% vs 18%; p=0.93). BAV had lower odds on univariate and multivariate analyses adjusted for age/sex/body mass index (OR 0.33 [CI 0.14–0.81]; p=0.01, OR 0.23 [CI 0.08–0.65]; p=0.01) of presenting with aSAH. Conclusion Within a large prospective registry with accurate aSAH diagnoses, we found 3-times lower prevalence of echocardiographically-confirmed BAV as compared to non-aSAH controls. We observed 3-times higher prevalence of BAV in controls than among aSAH cases. In addition, size of intracranial aneurysms was clinically smaller in BAV patients, and the severity of SAH was significantly lesser in BAV from a clinical standpoint. Our findings argue against routine surveillance for IA in BAV patients without CoA. FUNDunding Acknowledgement Type of funding sources: None.

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A case of bicuspid aortic valve with coarctation of aorta

International Surgery Journal ◽

10.18203/2349-2902.isj20172035 ◽

2017 ◽

Vol 4 (6) ◽

pp. 2101

Author(s):

Shubhadev Bhattacharya ◽

Sudesh Kumar ◽

Narender Singh Jhajhria ◽

Vijay Kumar Gupta

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Ascending Aorta ◽

Thoracic Wall ◽

Coarctation Of Aorta ◽

X Ray ◽

Strain Pattern ◽

2D Echocardiography ◽

Aortic Area ◽

Chest X Ray

A 28-year-old male patient presented with angina on exertion for 3 years, dyspnea on exertion for 2 years. On examination patient was average built, having slow rising pulse, with ejection systolic murmur over aortic area, radiating to carotids. Blood investigations were normal, ECG was suggestive of LV strain pattern, Chest X ray was suggestive of LV type apex with notching of inferior margins of ribs. 2D Echocardiography was done, and was suggestive of thickened calcified bicuspid aortic valve, aortic annulus 21 mm, ascending aorta 42 mm, Gradient across aortic valve Peak 100 mmHg, Mean 64 mmHg. Patient was referred for Aortic valve replacement. However, in view of borderline dilated ascending aorta, CT aortography was done, and was suggestive of membranous juxtaductal Coarctation of aorta with no antegrade contrast opacification suggesting total aortic occlusion with reformation of aorta through large systemic thoracic wall and mediastinal collaterals.

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Heritability of aortic valve stenosis and evidence of bicuspid enrichment in families with tricuspid aortic valve stenosis

European Heart Journal ◽

10.1093/ehjci/ehaa946.1874 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Boureau ◽

S Le Souarnec ◽

C Dina ◽

M Karakachoff ◽

R Capoulade ◽

...

Keyword(s):

Aortic Valve ◽

Bicuspid Aortic Valve ◽

Aortic Valve Stenosis ◽

Genetic Effect ◽

Prevalence Ratio ◽

Control Group ◽

Control Cohort ◽

University Hospitals ◽

Tricuspid Aortic Valve ◽

Genetic Heritability

Abstract Background Calcific aortic valve stenosis (CAVS) is the most common valvular heart disease. Although a familial component has been described, the heritability remains unknown. This study aimed to determine the heritability of CAVS and to compare the prevalence of bicuspid aortic valve (BAV) relatives among families with tricuspid and bicuspid aortic valve phenotype and to a control cohort. Methods Probands were recruited following aortic valve replacement in three French university hospitals. All relatives who agreed to participate were enrolled in the study. Families were defined as tricuspid aortic valve (TAV) or BAV families based on the aortic valve phenotype observed in the proband. As control group, we used probands diagnosed with mitral valve prolapse and their families. All recruited probands and relatives underwent comprehensive transthoracic echocardiography to determine aortic valve morphology and CAVS status. Additive genetic heritability was performed with SOLAR genetic statistics package. Prevalence of BAV relatives in each sub-group and Prevalence Ratio were calculated. Results Within the 2371 relatives coming from 138 CAVS families, the heritability of CAVS was significant (h2=0.49, p<0.001). Furthermore, TAV stenosis heritability was only significant in TAV families (h2=0.20, p=0.013). The prevalence of BAV was significantly higher in TAV families and BAV families than control families (5.96 [95% CI: 4.2–8.3%], [n=32 of 537] vs. 2.49 [95% CI: 1.3–4.7%], [n=9 of 361]; PR 2.64 [95% CI: 1.41–5.91]; p=0.005 and 10.20 [95% CI: 7.0–14.5%], [n=26 of 255] vs. 2.49 [95% CI: 1.3–4.7%], [n=9 of 361]; PR 4.63 [95% CI: 2.35–13.44]; p<0.001; respectively). Conclusions The heritability of aortic valve stenosis in this population confirms the genetic effect in determining aortic stenosis for all aortic valve phenotype and for tricuspid aortic valve. The bicuspid enrichment in TAV families suggests common genetic predisposition of aortic valve stenosis in some families. Taking all together, these findings encourage echocardiography screening of relatives of affected individuals. Funding Acknowledgement Type of funding source: None

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Effects of sports activity in athletes with bicuspid aortic valve and mild aortic regurgitation

British Journal of Sports Medicine ◽

10.1136/bjsm.2008.047407 ◽

2008 ◽

Vol 44 (4) ◽

pp. 275-279 ◽

Cited By ~ 27

Author(s):

G. Galanti ◽

L. Stefani ◽

L. Toncelli ◽

M. C. R. Vono ◽

R. Mercuri ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Regurgitation ◽

Bicuspid Aortic Valve ◽

Sports Activity

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Congenital laryngomalacia is related to exercise-induced laryngeal obstruction in adolescence

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-308450 ◽

2016 ◽

Vol 101 (5) ◽

pp. 443-448 ◽

Cited By ~ 24

Author(s):

Magnus Hilland ◽

Ola Drange Røksund ◽

Lorentz Sandvik ◽

Øystein Haaland ◽

Hans Jørgen Aarstad ◽

...

Keyword(s):

Exercise Test ◽

Quality Criteria ◽

Later Life ◽

University Hospital ◽

Respiratory Morbidity ◽

Control Group ◽

Laryngeal Obstruction ◽

Standard Quality ◽

Exercise Induced ◽

Laryngeal Anatomy

ObjectivesCongenital laryngomalacia (CLM) is the major cause of stridor in infants. Most cases are expected to resolve before 2 years of age, but long-term respiratory prospects are poorly described. We aimed to investigate if CLM was associated with altered laryngeal structure or function in later life.MethodsTwenty of 23 (87%) infants hospitalised at Haukeland University Hospital during 1990–2000 for CLM without comorbidities and matched controls were assessed at mean age 13 years. Past and current respiratory morbidity was recorded in a questionnaire, and spirometry performed according to standard quality criteria. Laryngoscopy was performed at rest and continuously throughout a maximal treadmill exercise test (continuous laryngoscopy exercise test (CLE-test)), and scored and classified in a blinded fashion according to preset criteria.ResultsIn the CLM group, laryngeal anatomy supporting CLM in infancy was described at rest in nine (45%) adolescents. Eleven (55%) reported breathing difficulties in relation to exercise, of whom 7 had similarities to CLM at rest and 10 had supraglottic obstruction during CLE-test. Overall, 6/20 had symptoms during exercise and similarities to CLM at rest and obstruction during CLE-test. In the control group, one adolescent reported breathing difficulty during exercise and two had laryngeal obstruction during CLE-test. The two groups differed significantly from each other regarding laryngoscopy scores, obtained at rest and during exercise (p=0.001 or less).ConclusionsCLM had left footprints that increased the risk of later exercise-induced symptoms and laryngeal obstruction. The findings underline the heterogeneity of childhood respiratory disease and the importance of considering early life factors.

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Abstract 5770: Abnormal Aortic Root Elastic Properties in Family Members of Bicuspid Aortic Valve Subjects, despite Normal Aortic Valve Morphology.

Circulation ◽

10.1161/circ.118.suppl_18.s_999 ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Asim Rafique ◽

Simon Biner ◽

Indraneil Ray ◽

Olivera Cuk ◽

Robert Siegel ◽

...

Keyword(s):

Aortic Valve ◽

Elastic Properties ◽

Bicuspid Aortic Valve ◽

Aortic Root ◽

Family Members ◽

Structural Heart Disease ◽

Aortic Distensibility ◽

Stiffness Index ◽

Valve Morphology ◽

2D Echocardiography

Background: Abnormal aorta dilatation and elastic properties have been documented in subjects with bicuspid aortic valve (BAV). 10% of first degree relatives (FDRs) of probands with BAV inherit this valvular abnormality. There is no data regarding the elastic properties of aortic root in family members of BAV subjects. We evaluated the elastic properties in FDRs with normal tricuspid aortic valves. Methods: Systolic and diastolic aortic root dimensions were measured by 2D echocardiography in BAV probands (n=48) their FDRs (n = 49) and controls without structural heart disease matched by age and gender (n=44) at sinuses of Valsalva level. In addition, systolic (SBP) and diastolic blood pressure (DBP) were measured to calculate aortic distensibility, stiffness index and strain. Results: Five subjects (10%) in FDR group were found to have BAV, thus they were included in BAV group. There was no difference in age, gender, SBP and DBP in the three groups. History of hypertension was less prevalent in FDRs when compared to BAV and controls (16% vs 43% and 33%, p=0.03). All three parameters of aortic elastic properties including distensibility ×10 −3 mmHg (1.2±1.0 and 1.5±1.1 vs 2.3±1.5, p<0.001), stiffness index (56.5±76.4 and 29.1±32.5 vs 12.6±9.2, p<0.001) and strain (2.9±2.4and 3.6±2.5 vs 6.0±3.6, p<0.001) were significantly worse in BAV and FDRs compared to controls (Figure ). Conclusions: Aortic root elastic properties are abnormal in the family members of subjects with BAV despite normal tricuspid aortic valve morphology. This finding supports the hypothesis that there is a common genetic basis for BAV and abnormal elastic properties of aorta.

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