Aortic Size Assessment by Noncontrast Cardiac Computed Tomography: Normal Limits by Age, Gender, and Body Surface Area

Wolak, Arik; Gransar, Heidi; Thomson, Louise; Friedman, John D.; Hachamovitch, Rory; Gutstein, Ariel; Shaw, Leslee J.; Polk, Donna M.; Wong, Nathan D.; Saouaf, Rola; Hayes, Sean W.; Rozanski, Alan; Slomka, Piotr J.; Germano, Guido; Berman, Daniel S.

doi:10.1016/j.jcmg.2007.11.005

Cited by 266 publications

(230 citation statements)

References 16 publications

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“…Accepted studies underlying classic echocardiographic guidelines are limited by small sample sizes and homogeneity of cohort studies [9]. More recent studies based on CT scan data have set out to establish distribution curves [10,11]; however, these are also limited by homogeneity in cohort character and original study indication (prejudicing observed aortic size).…”

Section: Introductionmentioning

confidence: 99%

Aortic Size Distribution in the General Population: Explaining the Size Paradox in Aortic Dissection

Paruchuri¹,

Salhab

Kuzmik³

et al. 2015

Cardiology

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Background: Current guidelines recommend a diameter of 5-5.5 cm as the threshold for surgery on the ascending aorta. However, a study from the International Registry of Acute Aortic Dissection showed that nearly 60% occurred at <5.5 cm (the ‘aortic size paradox') - leading to a debate whether the size threshold should be lowered. However, the study showing dissection at small size had no knowledge of the population at risk. Herein, we aim to calculate the relative risk of aortic dissection at sizes <5.5 cm by analyzing both the number of occurring dissections (numerator) and the population at risk at each aortic size (denominator). Methods: Using a publicly available database of 3,573 multiethnic subjects (46% male, mean age 60.7 years) from the general population, we plotted a distribution curve of ascending aortic size (by magnetic resonance imaging). The relative risk of aortic dissection was calculated by dividing the proportion of dissections occurring at each size (numerator) by the proportion of aortas of that same size in the general population (denominator). Results: The mean ascending aortic diameter of the reference population was 3.2 cm (±0.4 cm). The largest diameter was 4.9 cm in women and 5.0 cm in men. The proportion of subjects with an aorta <3.5 cm was 79.2%, that of subjects with 3.5-3.9 cm was 18.0%, that of subjects with 4.0-4.4 cm was 2.6%, and that of subjects with ≥4.5 cm was 0.22%. The relative risk of dissection in those categories was found to be 0.055, 2.5, 4.9, and 346.8, respectively. Patients with an aorta ≥4.5 cm were 6,305 times more likely to suffer aortic dissection than those with an aorta <3.5 cm. Conclusions: The normal aorta is deceptively small, most commonly <3.5 cm. The aortic size paradox is a byproduct of the very large number of patients in small size ranges. This study fully supports current recommendations for surgical intervention at 5-5.5 cm.

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Section: Introductionmentioning

confidence: 99%

Aortic Size Distribution in the General Population: Explaining the Size Paradox in Aortic Dissection

Paruchuri¹,

Salhab

Kuzmik³

et al. 2015

Cardiology

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“…21 The vascular contours were automatically traced for all phases of the cardiac cycle on both the modulus images of the phase contrast acquisition for flow analysis and on the cine images for aortic diameter/area analysis. 22 PWV was calculated by dividing the length of the aorta between the locations used for ascending and descending aortic flow measurements with the time difference between the arrival of the pulse wave at these locations at rest and stress. Transit time was defined as the temporal shift of the wave "foot" and required the location of both the local velocity minima at end diastole and the highest blood acceleration during the systolic "upslope."…”

Section: Discussionmentioning

confidence: 99%

Gender-Specific Differences in Myocardial Deformation and Aortic Stiffness at Rest and Dobutamine Stress

et al. 2012

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Abstract-Elderly women have increased aortic and ventricular stiffness but preserved global systolic function. Possible gender differences in ventricular deformation attributed to increased aortic stiffness at rest or with positive inotropic stress remain unknown. Eighty-four subjects (mean age: 63Ϯ8 years) were assessed for aortic stiffness by pulse wave velocity and ventricular deformation at rest and during dobutamine stress using magnetic resonance. At rest, women (nϭ40) had greater aortic stiffness and ventricular deformation than men (PϽ0.05). In men, dobutamine increased longitudinal (meanϮSD: 3.3Ϯ4.1%; PϽ0.01) and circumferential deformation (2.9Ϯ5.1%; Pϭ0.007), whereas women showed an increase in circumferential deformation only (4.8Ϯ6.3%; PϽ0.01). In men there was an inverse association between longitudinal deformation and pulse wave velocity at rest (rϭϪ0.51; Pϭ0.002) and linear at stress (rϭ0.52; Pϭ0.001). In women there were no significant relations at rest, whereas at stress longitudinal deformation was inversely associated with pulse wave velocity (rϭϪ0.43; Pϭ0.02). We demonstrate genderspecific differences in the relationship between aortic stiffness and ventricular deformation at rest and during dobutamine stress. Although at rest longitudinal deformation is inversely related to aortic stiffness in men, there is no such relationship in women. At stress, men improve longitudinal function, whereas in women such response is limited. Key Words: aortic stiffness Ⅲ pulse wave velocity Ⅲ myocardial deformation Ⅲ gender differences Ⅲ dobutamine stress Ⅲ cardiac imaging Ⅲ cardiac physiology and function A ging influences the structural and functional properties of the arterial and ventricular system: the central arteries dilate, and their walls become thicker and stiffer, adding onto the cardiac workload. 1,2 Elderly women appear to be particularly affected when compared with their male counterparts, even in the absence of cardiovascular (CV) disease and despite commonly preserved markers of global systolic function. 2,3 Aortic stiffness, assessed by the pulse wave velocity (PWV), is a marker of the pulsatile component of arterial afterload. 4 -6 Increased aortic stiffness contributes to increased left ventricular (LV) stiffness, dysfunction, and remodeling. [7][8][9][10][11] Experimental and clinical models suggest that longitudinal myocardial deformation is impaired early because of increased afterload, even when the global systolic function remains unaffected. 12,13 To date, no study examined how increased aortic stiffness relates to longitudinal myocardial systolic function or whether there are gender differences in myocardial deformation because of increased aortic stiffness. It is unclear how aortic stiffness and myocardial deformation react to acute alteration of systolic performance, such as with positive inotropic stress, 14 and whether these reactions are gender specific. We investigated gender-related differences of LV deformation and aortic stiffness at rest and dobutamine stress. MethodsEig...

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“…The thoracic aorta increases in diameter, elongates, and stiffens with advancing age 1, 2, 3, 4. Aortic arch width (AAW)5, 6 also increases with older age.…”

Section: Introductionmentioning

confidence: 99%

Aortic Arch Width and Cardiovascular Disease in Men and Women in the Community

Chuang

Gona

Qazi

et al. 2018

JAHA

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BackgroundWe sought to determine whether increased aortic arch width (AAW) adds to standard Framingham risk factors and coronary artery calcium (CAC) for prediction of incident adverse cardiovascular disease (CVD) events in community‐dwelling adults.Methods and ResultsA total of 3026 Framingham Heart Study Offspring and Third Generation cohort participants underwent noncontrast multidetector computed tomography from 2002 to 2005 to quantify CAC. We measured AAW as the distance between the centroids of the ascending and descending thoracic aorta, at the level of main pulmonary artery bifurcation or the right pulmonary artery. We determined sex, age group, and body size specific cut points for high (≥90th percentile) AAW from a healthy referent group (N=1471) and dichotomized AAW as high or not high across all study participants. Clinical covariates were obtained at Offspring cycle 7 (1998–2001) or Third Generation cycle 1 (2002–2005) examinations. The primary CVD outcome was a composite of myocardial infarction, coronary insufficiency, cerebrovascular accident, first hospitalization for heart failure, or CVD death. Cox proportional hazards models were used to estimate hazard ratio of high AAW on time‐to‐incident CVD after adjustment for Framingham risk factors and CAC. Net reclassification improvement was used to assess the effect of adding AAW to the baseline Framingham risk factor+CAC model. A total of 2826 participants (aged 51±11 years, 48% women) had complete covariates and were free of CVD at multidetector computed tomography. Over a median 8.9 years of follow‐up, there were 135 incident CVD events. High AAW was independently predictive of CVD events (hazard ratio, 1.55; P=0.032) and appropriately reclassified participants at risk: net reclassification improvement, 0.31 (95% confidence interval, 0.15–0.48).Conclusion AAW augments traditional CVD risk factors and CAC for prediction of incident adverse CVD events among community‐dwelling adults.

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Aortic Size Assessment by Noncontrast Cardiac Computed Tomography: Normal Limits by Age, Gender, and Body Surface Area

Abstract: Normal limits of ascending and descending aortic dimensions by noncontrast gated cardiac CT have been defined by age, gender, and BSA in a large, low-risk population of subjects undergoing CAC scanning.

Cited by 266 publications

References 16 publications

Aortic Size Distribution in the General Population: Explaining the Size Paradox in Aortic Dissection

Aortic Size Distribution in the General Population: Explaining the Size Paradox in Aortic Dissection

Gender-Specific Differences in Myocardial Deformation and Aortic Stiffness at Rest and Dobutamine Stress

Aortic Arch Width and Cardiovascular Disease in Men and Women in the Community

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