Proximal Aortic Distensibility Is an Independent Predictor of All-Cause Mortality and Incident CV Events

Abstract

BACKGROUND The predictive value of ascending aortic distensibility (AAD) for mortality and hard cardiovascular disease (CVD) events is not fully established. OBJECTIVES We sought to assess the utility of AAD to predict mortality and incident CVD events beyond conventional risk factors in the Multi-Ethnic Study of Atherosclerosis (MESA). METHODS AAD was measured with magnetic resonance imaging at baseline in 3,675 MESA participants free of overt CVD. Cox proportional-hazards regression was used to evaluate risk of death, heart failure (HF), and incident CVD in relation to AAD, CVD risk factors, indices of subclinical atherosclerosis, and Framingham risk score. RESULTS There were 246 deaths and 171 hard CVD (myocardial infarction, resuscitated cardiac arrest, stroke and cardiovascular [CV] death) and 88 HF events over a median 8.5-year follow-up. Decreased AAD was associated with increased all-cause mortality with a hazard ratio (HR) for the first verus fifth quintile of AAD of 2.7 (p = 0.008) independent of age, sex, ethnicity, other CVD risk factors, and indices of subclinical atherosclerosis. Overall, subjects with lowest AAD had an independent 2-fold risk of hard CVD events. Decreased AAD was associated with CV events in low-to-intermediate CVD risk individuals with an HR for the first quintile of AAD of 5.3 (p = 0.03) as well as with incident HF but not after full adjustment. CONCLUSIONS Decreased proximal aorta distensibility significantly predicts all-cause mortality and hard CV events among individuals without overt CVD. AAD may help refine risk stratification, especially among asymptomatic, low-to-intermediate risk individuals.

Relationship of Aortic Wall Distensibility to Mitral and Aortic Valve Calcification: The Multi-Ethnic Study of Atherosclerosis

“…These findings corroborate with the well-established association between AD and future risk of cardiovascular events, 18 where individuals older than 65 years have a 25% prevalence of developing AVC and are associated with a 50% increased risk of cardiovascular mortality. 19 Among our study, individuals with low or high AVC or MVC were found to have a higher Framingham risk score compared to those with zero AVC or MVC.…”

Noninvasive Imaging of Flow and Vascular Function in Disease of the Aorta

“…Similar predictive value of CMR-derived aortic distensibility for all cause mortality was shown in a population free of known CV disease from the Multi-ethnic Study of Atherosclerosis (72). In those with low and intermediate risk for CV disease, aortic distensibility also independently predicted CV events.…”

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

“…AAD represents a direct measure of the mechanical property of aortic stiffness. It is a less studied arterial stiffness index than PWV but has been shown to predict CVD and all-cause mortality in MESA [19]. AoPWV (m/s) was determined by dividing the distance (m) between the ascending and descending aorta (m/s) by the transit time.…”