{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T13:01:42Z","timestamp":1771851702329,"version":"3.50.1"},"reference-count":14,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,3,4]],"date-time":"2019-03-04T00:00:00Z","timestamp":1551657600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000009","name":"Foundation for the National Institutes of Health","doi-asserted-by":"publisher","award":["1R01HL137028"],"award-info":[{"award-number":["1R01HL137028"]}],"id":[{"id":"10.13039\/100000009","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Echocardiography"],"published-print":{"date-parts":[[2019,4]]},"abstract":"Background<\/jats:title>Bicuspid aortic valve (BAV<\/jats:styled-content>) is the most prevalent adult congenital heart defect. BAV<\/jats:styled-content> causes lifelong progressive disease that can be prevented by early diagnosis and long\u2010term surveillance, but may be compromised by misclassification of valve morphology.<\/jats:p><\/jats:sec>Methods<\/jats:title>The study population was derived from the UTH<\/jats:styled-content>ealth Bicuspid Aortic Valve Registry, which includes serial images on more than 200 participants over a mean follow\u2010up interval of 2.8\u00a0years. We abstracted descriptions of aortic valve morphology from transthoracic or transesophageal echocardiography, computed tomography angiography, and magnetic resonance angiography reports. We used chi\u2010square and t tests to determine associations between reported valve morphologies (definitely bicuspid, possibly bicuspid, tricuspid, or uncertain) and clinical characteristics and assessed image quality using a validated tool.<\/jats:p><\/jats:sec>Results<\/jats:title>About 40% of participants were misclassified in at least one imaging report. The mean interval between misclassification and correct diagnosis was 22\u00a0months. TEE<\/jats:styled-content>, MR<\/jats:styled-content> and CT<\/jats:styled-content> were more sensitive than TTE<\/jats:styled-content> and successfully reclassified 20% of participants, but were only used in 14% of patients. Misclassification was associated with age, the extent of valve calcification and image quality, but was not significantly associated with aortic regurgitation, gender, or cusp configuration.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Misclassification of BAV<\/jats:styled-content> is prevalent, frequently leads to delayed diagnosis, and is more likely to occur in the most severely affected cases. TEE<\/jats:styled-content>, CT<\/jats:styled-content> and MR<\/jats:styled-content> may increase diagnostic accuracy in up to half of BAV<\/jats:styled-content> cases but are underutilized. Additional studies are needed to determine if misclassification of BAV<\/jats:styled-content> patients leads to increased long\u2010term morbidity and mortality.<\/jats:p><\/jats:sec>","DOI":"10.1111\/echo.14295","type":"journal-article","created":{"date-parts":[[2019,3,5]],"date-time":"2019-03-05T03:31:00Z","timestamp":1551756660000},"page":"761-765","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Misclassification of bicuspid aortic valves is common and varies by imaging modality and patient characteristics"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1048-3555","authenticated-orcid":false,"given":"Peyton M.","family":"Cramer","sequence":"first","affiliation":[{"name":"Department of Internal Medicine McGovern Medical School University of Texas Health Science Center at Houston Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siddharth K.","family":"Prakash","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine McGovern Medical School University of Texas Health Science Center at Houston Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,3,4]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2005.04.051"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9149(70)90761-7"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2018.02.115"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.2214\/AJR.09.3813"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acra.2011.10.012"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jeu055"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.4250\/jcu.2015.23.1.1"},{"key":"e_1_2_8_9_1","first-page":"48","article-title":"Reliability of transthoracic echocardiography in the assessment of aortic valve morphology: pathological correlation in 178 patients","volume":"15","author":"Chan KL","year":"1999","journal-title":"Can J Cardiol"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.1286"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-017-1107-1"},{"key":"e_1_2_8_12_1","unstructured":"LopezL TacyT BenavidezO et\u00a0al.American College of Cardiology: Adult Congenital and Pediatric Cardiology Section Quality Metric #026: Initial Transthoracic Echocardiogram Image Quality.https:\/\/cvquality.acc.org\/initiatives\/acpc-quality-network\/quality-metrics. Accessed May 2018."},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2010.11.006"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcmg.2013.10.005"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2014.05.014"}],"container-title":["Echocardiography"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fecho.14295","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.14295","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/echo.14295","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/echo.14295","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,10]],"date-time":"2023-09-10T12:05:31Z","timestamp":1694347531000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/echo.14295"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,3,4]]},"references-count":14,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1111\/echo.14295"],"URL":"https:\/\/doi.org\/10.1111\/echo.14295","archive":["Portico"],"relation":{},"ISSN":["0742-2822","1540-8175"],"issn-type":[{"value":"0742-2822","type":"print"},{"value":"1540-8175","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,3,4]]},"assertion":[{"value":"2018-09-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-01-30","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-03-04","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}