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To the Editor: In their study of outcomes in adults with bicuspid aortic valves, Dr Tzemos and colleagues¹ concluded that age, severity of aortic stenosis, and severity of aortic regurgitation were independently associated with primary cardiac events. Identification of outcome predictors that could help in the selection of patients who are likely to benefit from intervention such as surgery would be highly desirable.

Valvular calcification was not described in the study by Tzemos et al, although the extent of such calcification has been found to be a strong independent predictor of outcome of aortic stenosis,² congruent with how the disease process at the tissue level is understood. In addition, valvular calcification increases leaflet stiffness and reduces systolic opening, eventually leading to a reduction in the area of the valve, so calcification could be present before aortic stenosis. If valvular calcification was independently associated with primary cardiac events, it may be . . . [Full Text of this Article]

Ze-Zhou Song, MS
zezhou_song@126.com
Department of Ultrasound
The First Affiliated Hospital
Zhejiang University
Hangzhou, China

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Outcomes in Adults With Bicuspid Aortic Valves
Nikolaos Tzemos, Judith Therrien, James Yip, George Thanassoulis, Sonia Tremblay, Michal T. Jamorski, Gary D. Webb, and Samuel C. Siu
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