BAV-IE often presents with delayed diagnosis, increasing the risk of major complications. A study published in the Journal of the American College of Cardiology compared symptom-to-diagnosis time and outcomes in BAV-IE and TAV-IE.

The retrospective cohort included 52 patients with BAV-IE (mean age 47 ± 15 years; 85% male) and 244 patients with TAV-IE (mean age 65 ± 14 years; 72% male). Clinical features, microbiologic findings, and infectious endocarditis-related major adverse cardiovascular events (IE-MACE: perivalvular extension, septic embolism, heart failure, or surgery) were extracted from electronic health records. Symptom-to-diagnosis intervals and causative organisms were evaluated, and logistic regression identified predictors of IE-MACE.

Streptococcal infections were more frequent in BAV-IE (54% vs 28%; P = 0.0004), and suspected dental procedure sources were higher as well (19% vs 2%; P = 0.006). Median symptom-to-diagnosis time was significantly longer in BAV-IE (34 vs 7 days; P < 0.0001). IE-MACE occurred in 96% of BAV-IE cases compared with 64% of TAV-IE (P < 0.0001). Age, bicuspid anatomy, and diagnostic delay were independently associated with adverse outcomes. Unadjusted four-year survival appeared higher in BAV-IE, but the difference was not significant after adjusting for age and sex.

These findings show that prolonged diagnostic intervals in BAV-IE were associated with a significantly higher complication burden.