Objectives A new nomenclature and classification of the bicuspid aortic valve (BAV) was proposed. However, phenotyping using echocardiography remains limited in accuracy. This study aimed to evaluate the utility of cardiac CT for BAV phenotyping and its association with clinical relevance. Materials and methods Four hundred eighteen BAV patients who underwent both echocardiography and cardiac CT within 3 months were analyzed. BAV was classified as fused, 2-sinus, or partial-fusion type. We investigated the association between the CT-derived BAV phenotype and types of BAV dysfunction and aortopathy. Results CT-derived BAV phenotypes showed 58.6% concordance with echocardiography-based phenotypes. Fifty patients (12.0%) had a partial-fusion type based on echocardiography, but 124 patients (29.7%) had this type based on CT. CT-derived fused and 2-sinus type had a higher incidence of significant aortic stenosis than the other CT-based phenotypes [adjusted odds ratio (aOR):1.21, 95% CI: 1.12–1.31, p < 0.001; aOR: 1.14, 95% CI: 1.05–1.23, p = 0.002, respectively]. Partial-fusion type was associated with a higher incidence of significant aortic regurgitation (aOR: 1.50, 95% CI: 1.38–1.63, p < 0.001) and lower incidence of ascending-type aortopathy (aOR:0.88, 95% CI: 0.80–0.97, p = 0.008). In the 2-sinus BAV subgroup, a latero-lateral opening was more significantly associated with all types of aortopathy than the antero-posterior opening type (aOR:1.23, 95% CI: 1.05–1.43, p = 0.011). Conclusions Cardiac CT provides accurate information for BAV phenotype using the new nomenclature system. CT-derived BAV phenotyping is associated with types of BAV dysfunction and aortopathy and may therefore be useful for risk prediction in patients with a BAV. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> Echocardiographic phenotyping of BAV is limited in accuracy. This study evaluated the utility and clinical relevance of CT-based BAV phenotyping. <Emphasis Type="BoldItalic">Findings</Emphasis> CT and echocardiography showed 58.6% agreement in BAV phenotyping. CT identified more partial-fusion types and was significantly associated with valve dysfunction and aortic disease. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> Cardiac CT provides accurate BAV phenotyping using the new nomenclature. CT-derived phenotype correlates with BAV dysfunction and aortic disease, suggesting its potential role in risk stratification and personalized management of patients with BAV. Graphical Abstract

Bicuspid aortic valve phenotyping by cardiac computed tomography and its clinical implications

期刊论文
发表日期：

2026年1月28日

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Kyu Kim,
Suji Lee,
Seo-Yeon Gwak,
Hyun-Jung Lee,
Young Joo Suh,
Iksung Cho,
Geu-Ru Hong,
Jong-Won Ha,
Young Jin Kim,
Chi Young Shim

摘要

Objectives

A new nomenclature and classification of the bicuspid aortic valve (BAV) was proposed. However, phenotyping using echocardiography remains limited in accuracy. This study aimed to evaluate the utility of cardiac CT for BAV phenotyping and its association with clinical relevance.

Materials and methods

Four hundred eighteen BAV patients who underwent both echocardiography and cardiac CT within 3 months were analyzed. BAV was classified as fused, 2-sinus, or partial-fusion type. We investigated the association between the CT-derived BAV phenotype and types of BAV dysfunction and aortopathy.

Results

CT-derived BAV phenotypes showed 58.6% concordance with echocardiography-based phenotypes. Fifty patients (12.0%) had a partial-fusion type based on echocardiography, but 124 patients (29.7%) had this type based on CT. CT-derived fused and 2-sinus type had a higher incidence of significant aortic stenosis than the other CT-based phenotypes [adjusted odds ratio (aOR):1.21, 95% CI: 1.12–1.31, p < 0.001; aOR: 1.14, 95% CI: 1.05–1.23, p = 0.002, respectively]. Partial-fusion type was associated with a higher incidence of significant aortic regurgitation (aOR: 1.50, 95% CI: 1.38–1.63, p < 0.001) and lower incidence of ascending-type aortopathy (aOR:0.88, 95% CI: 0.80–0.97, p = 0.008). In the 2-sinus BAV subgroup, a latero-lateral opening was more significantly associated with all types of aortopathy than the antero-posterior opening type (aOR:1.23, 95% CI: 1.05–1.43, p = 0.011).

Conclusions

Cardiac CT provides accurate information for BAV phenotype using the new nomenclature system. CT-derived BAV phenotyping is associated with types of BAV dysfunction and aortopathy and may therefore be useful for risk prediction in patients with a BAV.

Key Points

Question Echocardiographic phenotyping of BAV is limited in accuracy. This study evaluated the utility and clinical relevance of CT-based BAV phenotyping.

Findings CT and echocardiography showed 58.6% agreement in BAV phenotyping. CT identified more partial-fusion types and was significantly associated with valve dysfunction and aortic disease.

Clinical relevance Cardiac CT provides accurate BAV phenotyping using the new nomenclature. CT-derived phenotype correlates with BAV dysfunction and aortic disease, suggesting its potential role in risk stratification and personalized management of patients with BAV.

Graphical Abstract