Original ArticleEchocardiographic Prevalence of Bicuspid Aortic Valve in the Population
Introduction
The bicuspid aortic valve (BAV) is one of the most common congenital heart defects. It can progress to aortic stenosis or regurgitation and is associated with higher rates of infectious endocarditis. The exact prevalence of the condition is not known.
The prevalence of BAV was originally estimated from reviews of autopsy series. In the 1920s Lewis and Grant found the prevalence of bicuspid aortic valve to be 1.4% and 0.9%, respectively.1, 2 Roberts later published data supporting the figure of 0.9%.10 Very large studies were closer to the higher figure of 1.2–1.4%.4, 5
In the 1990s studies were first done using echocardiographic screening of asymptomatic populations. One large study in Africa found a considerably lower prevalence of 0.1%.11 However, two smaller but more recent studies found rates between 0.5% and 0.6%.12, 13 The largest study to date combined both methods by analyzing the autopsy reports, medical records and an echocardiographic database involving 44,013 children born in Iceland. This showed an overall prevalence of 0.1%.
The goal of our study was to clarify the actual prevalence of BAV. We have at the University of California, Irvine, a large database of 23,957 echocardiographic studies done for a wide spectrum of diagnoses. We also have a database of 1742 screening echocardiograms done on teenage athletes. Each of these databases is larger than any previously published studies reporting on the echocardiographic prevalence of BAV. The UC Irvine database, by itself, is larger than the largest autopsy series published on this matter (Table 1).
Section snippets
Methods
We retrospectively analyzed two large databases. One included 24,265 echocardiograms performed at our institution ordered by clinicians between 1984 and 1998 for various indications. The echocardiograms were interpreted by different cardiologists at our institution during study period. The diagnosis of BAV was based on visual estimation by the interpreting cardiologists. The second database was from a study of 1742 echocardiograms performed during the screening of a large number of healthy
Results
The first database revealed a gender distribution of 11,339 male (47%) and 12,926 (53%) female patients. The second database consisted of 1172 (67%) male and 570 (33%) female athletes. The echocardiographic prevalence of BAV was 0.6% in the larger database and 0.5% in the smaller athletic database (Table 2). The mean age of patients with BAV in the larger of the two echocardiographic databases was 31.8 ± 14.3 vs. 51.4 ± 18.5 years in those without BAV. The mean age of athletes with BAV was 15.6 ± 3.8
Discussion
Using two large databases we found that the prevalence of bicuspid aortic valve was between 0.5% and 0.6%. This figure matches the results found by two other smaller echocardiographic studies which used prospective screening of children and adolescents.12, 13 It also approximates the results of the two latest autopsy series to be published.7, 8 It is far greater than the 0.1% reported from largest study to date, using medical records, autopsy studies and an echocardiographic database of 44,000
Limitations
Our data were extracted from databases and therefore the study was not prospective. The diagnosis of BAV was not independently verified. The echocardiograms were interpreted by different cardiologists and we cannot determine the inter-observer variability or adherence to established guidelines. The diagnosis of BAV is a subjective diagnosis and dependent on the quality of images. Therefore, the prevalence of BAV could have been underestimated.
Conclusion
We found the prevalence of bicuspid aortic valve in two large databases to be between 0.5% and 0.6%. This figure was consistent across different ages, in both databases. The ratio of males to females affected was three or four to one.
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