The aim of this study was to compare the calcium burden of the aortic valve and coronary arteries with multidetector computed tomography (MDCT) in a propensity score-matched population of patients with a bicuspid versus a tricuspid aortic valve. From an ongoing clinical registry of patients who underwent MDCT, 70 patients with bicuspid aortic valve and 210 patients with tricuspid aortic valve were matched based on age, gender, cardiovascular risk factors, chest pain symptoms, and MDCT indication. Aortic valve calcium and the presence and severity of coronary artery disease were analyzed. Patients were divided into age quintiles. The median Agatston coronary artery score (27 [0 to 563] vs 0 [0 to 57], p = 0.003) was higher in patients with a tricuspid aortic valve compared with those with a bicuspid aortic valve. In contrast, patients with bicuspid aortic valve had a significantly larger calcium volume of the aortic valve than those with tricuspid aortic valve (391 [43 to 2,028] mm3 vs 0 [0 to 1,844] mm3, p <0.001). In patients with bicuspid aortic valve, the calcification process of the aortic valve started at an earlier age (second quintile 35 to 51 years) compared with those with tricuspid aortic valve, whereas the coronary atherosclerosis process was similar in both groups. In conclusion, patients with bicuspid aortic valve show larger aortic valve calcium load and at earlier age than those with tricuspid aortic valve, independently from the extent of calcium in the coronary arteries. Calcific deposits were heavier in bicuspid than in tricuspid valves.
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