Quadricuspid Aortic Valve Has Higher Heart Failure Risk Than Bicuspid Valve - EMJ

Quadricuspid Aortic Valve Has Higher Heart Failure Risk Than Bicuspid Valve

PATIENTS with quadricuspid aortic valve (QAV) face a similarly high need for aortic valve interventions as those with bicuspid aortic valve (BAV), but they have a greater risk of hospitalisation for heart failure and more coexisting cardiomyopathies. Survival rates are comparable between the two groups and the general population. 

Congenital aortic valve disease most commonly presents as BAV, affecting about 0.8 to 1% of the population, while QAV is rare. The clinical outcomes and management strategies for QAV are less understood. A clearer comparison of morbidity and survival between QAV and BAV patients is essential to guide clinical practice and patient monitoring. 

This retrospective cohort study reviewed 2,945,132 echocardiographic exams from two tertiary hospitals in China from 2011 to 2023. Researchers included 139 patients with QAV and matched them by age and sex (1:5 ratio) to 695 patients with BAV. Over a median follow-up of 4.8 years, the cumulative incidence of aortic valve intervention was high and similar for both groups (QAV 77.4% vs BAV 75.7%; P=0.26). QAV patients had significantly fewer aortic surgeries (5.1% vs 33.8%; P<0.001) and no cases of infective endocarditis, compared to 9.6% in BAV patients (P=0.01). Aortic dissection was rare in both groups. Adjusted analyses showed QAV was associated with over twice the risk of heart failure hospitalisation (hazard ratio 2.52; 95% CI 1.51–4.20; P<0.001), with cardiomyopathies strongly linked to this risk (hazard ratio 4.27). Five-year relative survival exceeded 100% for both groups compared to age- and sex-matched population controls. 

These findings highlight the need for closer surveillance of valve function and systematic cardiomyopathy screening in patients with QAV. Despite the burden of valve-related morbidity, overall survival remains excellent. Future clinical efforts should focus on tailored monitoring and management to mitigate heart failure risk in QAV individuals. 

Reference 

Zhang J et al. Clinical outcomes in patients with quadricuspid vs bicuspid aortic valve. JAMA Netw Open. 2025;8(8):e2524915.

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