Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm

Zafar, Mohammad A.; Li, Yupeng; Rizzo, John A.; Charilaou, Paris; Saeyeldin, Ayman; Velásquez, Camilo A.; Mansour, Ahmed M.; Mahmood, Syed Usman Bin; Ma, Wei-Guo; Brownstein, Adam J.; Tranquilli, Maryann; Dumfarth, Julia; Theodoropoulos, Panagiotis; Thombre, Kabir; Tanweer, Maryam; Erben, Young; Peterß, Sven; Ziganshin, Bulat A.; Elefteriades, John A.

doi:10.1016/j.jtcvs.2017.10.140

Cited by 188 publications

(152 citation statements)

References 27 publications

(31 reference statements)

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“…Multiple linear regression was used to compare the three outcomes across the three AHI-based severity groups, adjusting for age, sex, race, BSA, systolic BP, antihypertensive medication status, diabetes, smoking, and cholesterol levels. We ran an additional model in which height was substituted for BSA [20]. Effect modification by age, sex, and race/ethnicity were tested by including each cross-product terms in the models.…”

Section: Methodsmentioning

confidence: 99%

Obstructive Sleep Apnea and Structural/Functional Properties of the Thoracic Ascending Aorta: The Multi-Ethnic Study of Atherosclerosis (MESA)

et al. 2019

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Background: Structural and functional properties of the proximal thoracic aorta have important implications in clinical and subclinical cardiovascular disease (CVD). We examined whether obstructive sleep apnea (OSA) is associated with proximal aortic size and aortic stiffness in a multi-ethnic community-based cohort. Methods: The sample included the Multi-Ethnic Study of Atherosclerosis (MESA) Sleep Ancillary study participants without known CVD who underwent cardiac magnetic resonance imaging. The main exposure variable was OSA severity based on the polysomnography-derived apnea hypopnea index (AHI; normal, AHI <5/h; mild, 5≤ AHI <15/h; moderate to severe, AHI ≥15/h). The study outcomes were ascending aortic diameter (AoD, cm), aortic pulse wave velocity (AoPWV, m/s), and ascending aortic distensibility (AAD, %/mm Hg). Analyses were performed in the overall sample and in sex-specific strata, adjusted for multiple potential confounders. Results: The 708 participants were 55.9% female and on average 68 years old (54–93 years). There was a significant trend (p < 0.0001) of greater mean (SD) AoD across the three OSA groups: normal (n = 87), 3.13 cm (0.35); mild (n = 215), 3.25 (0.34); moderate to severe (n = 406), 3.37 (0.36). In adjusted analysis, participants with moderate to severe OSA had a greater mean AoD compared with the normal group: adjusted mean difference (95% CI), 0.12 cm (0.05, 0.20), p = 0.002. This AoD gradient was observed in women but not in men (p for interaction = 0.02). No differences were found in AoPWV or AAD among the OSA groups. Conclusion: In a diverse community-based cohort, moderate to severe OSA (vs. no OSA) was associated with a larger ascending AoD in women.

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Section: Methodsmentioning

confidence: 99%

Obstructive Sleep Apnea and Structural/Functional Properties of the Thoracic Ascending Aorta: The Multi-Ethnic Study of Atherosclerosis (MESA)

et al. 2019

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“…Interventional recommendations based on ASI cut‐offs are ≤2.05 (low risk = radiographic follow‐up), 2.08‐2.95 (moderate risk = close radiographic follow‐up), 3.00‐3.95 (high risk = elective repair recommended), and 4 cm/m 2 (severe risk = elective surgical repair as soon as possible). Recently, we introduced the AHI that simply divides the aortic size (maximum diameter) by patient height (does not involve complex BSA measurements) . Cut‐offs identifying risk categories for AHI are ≤2.43 (low risk), 2.44‐3.17 (moderate risk), 3.21‐4.06 (high risk), and ≥4.1 cm/m (severe risk) .…”

Section: Discussionmentioning

confidence: 99%

“…Recently, we introduced the AHI that simply divides the aortic size (maximum diameter) by patient height (does not involve complex BSA measurements) . Cut‐offs identifying risk categories for AHI are ≤2.43 (low risk), 2.44‐3.17 (moderate risk), 3.21‐4.06 (high risk), and ≥4.1 cm/m (severe risk) . Surgical recommendations are similar among ASI and AHI for each risk category, respectively, as they correlate with the same risk quantitatively (Table ).…”

Section: Discussionmentioning

confidence: 99%

Spontaneous rupture of the ascending aorta

et al. 2018

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“…Previous work by our group has addressed the natural history of thoracic aortic aneurysms (TAAs) (12)(13)(14)(15)(16)(17); herein, the aim of our current study is to assess the natural course of the aortic root specifically in MFS patients. We feel that the focus on the MFS aortic root may produce information of clinical value, as the root is the source of lethal complications in these patients.…”

Section: Introductionmentioning

confidence: 99%

Natural history of aortic root aneurysms in Marfan syndrome

Saeyeldin

Zafar

Velásquez

et al. 2017

Ann. Cardiothorac. Surg.

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Background: Cardiovascular complications account for a significant proportion of the shortened lifespan of Marfan syndrome (MFS) patients, with aortic dissection being the most dreadful complication. The aortic root dilates initially in MFS patients, and given its important hemodynamic role, this can lead to aortic regurgitation and poses a substantial risk of aortic dissection. This study seeks to evaluate the natural history of aortic root aneurysms in MFS patients, with a focus on growth rates and correlation of root diameter with the risk of developing aortic complications.Methods: Seventy-eight patients confirmed to have MFS and aortic root dilatation were retrospectively reviewed, and their aortic root diameters serially analyzed. Annual growth rate estimates and yearly rates of adverse events were computed and correlated with aortic diameter. Results:The mean annual growth rate of the aortic root was estimated to be 0.26±0.05 cm/year (range 0.13 to 0.35 cm). Larger aneurysms grew faster, reaching up to 0.46 cm/year for aneurysms >6 cm. Mean age at onset of aortic dissection was 36±4 years. Annual rates of adverse events (rupture, dissection and death) were obtained using a logistic regression model at sizes 3.5, 4, 4.5, 5, 5.5 and 6 cm. A sharp increase of 23% in the probability of the risk of complications at diameters 5.5 to 6 cm was recognized.Conclusions: Aortic root aneurysms in MFS patients tend to have a faster expansion rate compared to non-MFS individuals, with aortic root diameter having a significant impact on the yearly risk of developing aortic complications.

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Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm

Abstract: Compared with indices including weight, the simpler height-based ratio (excluding weight and BSA calculations) yields satisfactory results for evaluating the risk of natural complications in patients with TAAA.

Cited by 188 publications

References 27 publications

Obstructive Sleep Apnea and Structural/Functional Properties of the Thoracic Ascending Aorta: The Multi-Ethnic Study of Atherosclerosis (MESA)

Obstructive Sleep Apnea and Structural/Functional Properties of the Thoracic Ascending Aorta: The Multi-Ethnic Study of Atherosclerosis (MESA)

Spontaneous rupture of the ascending aorta

Natural history of aortic root aneurysms in Marfan syndrome

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