{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T15:08:44Z","timestamp":1790176124440,"version":"4.1.0"},"reference-count":25,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2023,6,20]],"date-time":"2023-06-20T00:00:00Z","timestamp":1687219200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Aortic stenosis is characterized by fibrosis and calcification of the valve, with a higher proportion of fibrosis observed in women. Stenotic bicuspid aortic valves progress more rapidly than tricuspid valves, which may also influence the relative composition of the valve. We aimed to investigate the influence of cusp morphology on quantitative aortic valve composition quantified from contrast-enhanced computed tomography angiography in severe aortic stenosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Patients undergoing transcatheter aortic valve implantation with bicuspid and tricuspid valves were propensity matched 1:1 by age, sex, and comorbidities. Computed tomography angiograms were analysed using semi-automated software to quantify the fibrotic and calcific scores (volume\/valve annular area) and the fibro-calcific ratio (fibrotic score\/calcific score). The study population (n = 140) was elderly (76 \u00b1 10 years, 62% male) and had a peak aortic jet velocity of 4.1 \u00b1 0.7 m\/s. Compared with those with tricuspid valves (n = 70), patients with bicuspid valves (n = 70) had higher fibrotic scores [204 (interquartile range 118\u2013267) vs. 144 (99\u2013208) mm3\/cm2, P = 0.006] with similar calcific scores (P = 0.614). Women had greater fibrotic scores than men in bicuspid [224 (181\u2013307) vs. 169 (109\u2013247) mm3\/cm2, P = 0.042] but not tricuspid valves (P = 0.232). Men had greater calcific scores than women in both bicuspid [203 (124\u2013355) vs. 130 (70\u2013182) mm3\/cm2, P = 0.008] and tricuspid [177 (136\u2013249) vs. 100 (62\u2013150) mm3\/cm2, P = 0.004] valves. Among both valve types, women had a greater fibro-calcific ratio compared with men [tricuspid 1.86 (0.94\u20132.56) vs. 0.86 (0.54\u20131.24), P = 0.001 and bicuspid 1.78 (1.21\u20132.90) vs. 0.74 (0.44\u20131.53), P = 0.001].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In severe aortic stenosis, bicuspid valves have proportionately more fibrosis than tricuspid valves, especially in women.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjci\/jead142","type":"journal-article","created":{"date-parts":[[2023,6,20]],"date-time":"2023-06-20T14:30:40Z","timestamp":1687271440000},"page":"1653-1660","source":"Crossref","is-referenced-by-count":20,"title":["Influence of cusp morphology and sex on quantitative valve composition in severe aortic stenosis"],"prefix":"10.1093","volume":"24","author":[{"given":"Kush P","family":"Patel","sequence":"first","affiliation":[{"name":"Department of Cardiology, Barts Health NHS Trust , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Lin","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Barts Health NHS Trust , London , UK"},{"name":"Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute , 116N Robertson Blvd, Suite 400, Los Angeles, CA 90048 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niraj","family":"Kumar","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Barts Health NHS Trust , London , UK"},{"name":"Institute of Cardiovascular Science, University College London , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giulia","family":"Esposito","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Barts Health NHS Trust , London , UK"},{"name":"Institute of Cardiovascular Science, University College London , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kajetan","family":"Grodecki","sequence":"additional","affiliation":[{"name":"Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute , 116N Robertson Blvd, Suite 400, Los Angeles, CA 90048 , USA"},{"name":"First Department of Cardiology, Medical University of Warsaw , Banacha 1A, 02-097 Warsaw , Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guy","family":"Lloyd","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Barts Health NHS Trust , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Mathur","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Barts Health NHS Trust , London , UK"},{"name":"Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7707-2254","authenticated-orcid":false,"given":"Andreas","family":"Baumbach","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Barts Health NHS Trust , London , UK"},{"name":"Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London , London , UK"},{"name":"Yale University School of Medicine , New Haven, CT , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J","family":"Mullen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Barts Health NHS Trust , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle C","family":"Williams","sequence":"additional","affiliation":[{"name":"University of Edinburgh\/British Heart Foundation Centre for Cardiovascular Science , Edinburgh , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E","family":"Newby","sequence":"additional","affiliation":[{"name":"University of Edinburgh\/British Heart Foundation Centre for Cardiovascular Science , Edinburgh , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A","family":"Treibel","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Barts Health NHS Trust , London , UK"},{"name":"Institute of Cardiovascular Science, University College London , London , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc R","family":"Dweck","sequence":"additional","affiliation":[{"name":"University of Edinburgh\/British Heart Foundation Centre for Cardiovascular Science , Edinburgh , UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2236-6970","authenticated-orcid":false,"given":"Damini","family":"Dey","sequence":"additional","affiliation":[{"name":"Departments of Biomedical Sciences and Medicine, Cedars-Sinai Medical Center, Biomedical Imaging Research Institute , 116N Robertson Blvd, Suite 400, Los Angeles, CA 90048 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,6,20]]},"reference":[{"key":"2023112322345568700_jead142-B1","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.jacc.2015.05.066","article-title":"Calcification in aortic stenosis: the skeleton key","volume":"66","author":"Pawade","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"2023112322345568700_jead142-B2","doi-asserted-by":"crossref","first-page":"1202","DOI":"10.1016\/j.jacc.2014.05.066","article-title":"Impact of aortic valve calcification, as measured by 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