THESIS PROTOCOL

TO STUDY THE MORPHOLOGICAL CHARACTERISTICS OF

AORTIC VALVE IN AORTIC STENOSIS PATIENTS

DR. RAJESH JAKHAR

Senior Resident
Department of Cardiology
AIIMS , New Delhi
Jan 2024 batch
 CHIEF GUIDE

DR. AMBUJ ROY (Professor, Department of cardiology, AIIMS, NEW DELHI)

 INTRODUCTION

 Aortic stenosis is one of the most common primary valve lesion requiring surgery
or transcatheter intervention.
 Its prevalence is rising rapidly as consequence of the ageing population.1
 In the population based echocardiographic studies, 1-2% of persons aged 65 or
older and 12% of person 75 or older had calcific aortic stenosis. Among those
older than 75, 3.4% have severe AS. 2
 Aortic valve morphologies can be unicuspid, bicuspid and tricuspid.

1. Yadgir et al. Global,regional, and national burden of calcific aortic valve and degenerative mitral valve
diseases, 1990-2017. Circulation 2020;141.
2. d’Arcy JL et al. Large- scale community echocardiographic screening reveals a major burden of undiagnosed
 Bicuspid Aortic valve is present in approximately 0.5-2% of the population, causing
significant AS in 12-37% of affected individuals.
 Calcific AS once was considered to represent the result of years of normal mechanical
stress on an otherwise normal valve, it is now clear that active biological process
underlies the initiation and progression of calcified aortic valve disease.
So the distribution of calcification on aortic valves may correlate to disease progression
and severity of pressure gradient.
PRIMARY OBJECTIVES

• To study tricuspid, bicuspid and unicuspid aortic valve morphologies in severe aortic
stenosis patients in Indian population.
• Correlation of aortic valve calcification and pressure gradient in mild, moderate and
severe aortic stenosis patients.
SECONDARY OBJECTIVES

• To sub-classify bicuspid aortic valve

• Prevalence of associated aortopathies and type of aortopathies.
• Correlation of aortic valve morphology with valve and aortic calcium scoring
• Associated coronary abnormalities
REVIEW OF LITERATURE

Authar AIM/ Sample size Year Results/

OBJECTIVE Conclusion

Guannan Niu et Anatomical 293 2022 32.4% were

al. morphology of bicuspid
Aortic valve in
Chinese
symptomatic severe
Aortic stenosis
patients

Hasan Jilaihawi Morphological 120 2015 50.7% were

et al. characteristics in tricuspid
Severe AS 47.5% were
bicuspid
1.7 % were
unicuspid
Authar Aim/Objective Sample Size Year Results/
Conclusion

Ralf Koos et al. Aortic valve 72 2004 Higher the aortic

calcification as a valve calcification
marker for AS scores indicates
severity higher aortic valve
gradient and
inversely related
to valve area.
METHODOLOGY

• STUDY DESIGN : Cross sectional study

• STUDY POPULATION : Patients of Severe Aortic Stenosis lesion Attending-

• Cardiology-OPD/Inpatient/Emergency Departments in AIIMS NEW DELHI

• SAMPLE SIZE : 100

INCLUSION CRITERIA

• Patients with Aortic Stenosis- mild, moderate and severe

• Age group > 40 years
EXCLUSION CRITERIA

• eGFR < 60 ml/min/1.72mt2

• Patients not giving consent
• Hemodynamic Decompensation/ ADHF
 THE PROCESS
Patients of Aortic Stenosis

Morphological
 Collect demographic & characteristics of Aortic
clinical details Cardiac CT valve and aorta

 Baseline ECG/ECHO

EXCLUSIONS
• eGFR < 60 ml/min/1.72mt2
• Patients not giving consent
• Hemodynamic Decompensation/
ADHF
IMAGING PARAMETERS

• Prevalence of Morphology of Aortic valve – unicuspid/bicuspid/tricuspid

• Subtype of bicuspid valve
• Distribution of aortic valve and aortic calcification
• Aortic dimensions
• Type of aortopathy
• Coronary abnormalities
SAMPLE SIZE CALCULATION

• Sample size calculation(n) =Z2(1-alpha/2) P(1-P)/d2

• With 95% confidence interval Z(1-alpha/2) =1.96

• P=Prevalence=32.4%

• d=precision (relative error of 10 %)

• Sample size = 1.962x0.34x(1-0.34)/0.1x0.1 = 83

THANK YOU