Reference Values for Echocardiographic Assessment of the Diameter of the Aortic Root and Ascending Aorta Spanning All Age Categories

Campens, Laurence; Demulier, Laurent; Groote, Katya De; Vandekerckhove, Kristof; Wolf, Daniël De; Roman, Mary J.; Devereux, Richard B.; Paepe, Anne De; Backer, Julie De

doi:10.1016/j.amjcard.2014.06.024

Cited by 173 publications

(172 citation statements)

References 27 publications

(17 reference statements)

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“…The majority of these patients (seven of eight; 88%) had ascending artic dimension > 50 mm. After calculation of the upper limit diameters for normal ascending aorta using the regression equation published by Campens et al [9], we found that the pathologically dilated ascending aorta was present in every second patient with BAV (56.7%) and significantly more often in individuals with type I BAV (67.4% vs. 33.3%, p = 0.009).…”

Section: Aortic Dimensionsmentioning

confidence: 93%

“…Additionally Khoo et al [4] showed significantly larger indexed diameters only at the level of the sinuses of Valsalva in patients with type I BAV. In our study we also used the regression equation published by Campens et al [9] to estimate the upper limit diameter for normal ascending aorta (considering gender, age, and BSA), which showed a more than two-times higher incidence of pathologically dilated ascending aorta in patients with type I BAV. That and our other previously mentioned findings support the thesis that type I BAV is associated with larger dimensions of the ascending aorta, excluding the annulus of AV as previously reported by other researchers [4,24].…”

Section: Discussionmentioning

confidence: 99%

“…To establish the upper limit diameters of aorta we applied the regression equation published by Campens et al [9] (considering age, body surface area [BSA], and sex of patient) derived from the reference healthy population.…”

Section: Estimation Of the Upper Limit Diameter Of Aortamentioning

confidence: 99%

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Bicuspid aortic valve morphology and its association with aortic diameter: an echocardiographic study

2016

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A b s t r a c tBackground: Bicuspid aortic valve (BAV) is strongly associated with aortopathy. Previous studies have suggested that various types of bicuspid aortic valve morphology may differently affect the aortic dilatation. Aim:To evaluate the impact of BAV cusp fusion morphology (type I -right-left coronary cusp fusion; type II -right-noncoronary cusp fusion) on the diameters of the aorta.Methods: BAV morphology was evaluated retrospectively in a group of 67 consecutive patients with BAV. The control group comprised 1000 randomly selected patients with normal tricuspid aortic valve. Aortic dimensions and other echocardiographic parameters were obtained from the echocardiography database of our department. The diameters of aorta in both BAV subtypes were evaluated at the level of: annulus, the sinus of Valsalva, the sinotubular junction, and the ascending aorta and at the level of the ascending aorta in the control group.Results: Patients with BAV were mainly male (78%), with a mean age of 55.3 ± 16.7 years. The dominant morphology of BAV in the study group was type I (n = 46; 69%). It was associated with increased aortic dimension in comparison to type II BAVs at the level of the sinuses of Valsalva (38.4 ± 5.2 vs. 34.0 ± 4.6 mm, p = 0.002), the sinotubular junction (33.1 ± 5.8 vs. 29.6 ± 5.0 mm, p = 0.035), and the ascending aorta (41.6 ± 7.1 vs. 36.6 ± 6.1 mm, p = 0.006). Indexed aortic diameter was also increased in type I BAV at the level of sinuses of Valsalva (19.6 ± 2.7 vs. 18.1 ± 1.6 mm/m 2 , p = 0.008) and the ascending aorta (21.3 ± 3.4 vs. 19.3 ± 3.4 mm/m 2 , p = 0.048). The dimensions of the ascending aorta exceeding the upper normal range limit based on control-group measurements (44.3 mm) were observed more frequently in type I than in type II (33% vs. 10%, p = 0.044). Aortic regurgitation (moderate or severe) occurred in similar percentages of both BAV subtypes (type I: 37% vs. type II: 33%, p = 0.774). There were also no significant differences in aortic valve area (2.2 ± 1.1 vs. 2.0 ± 1.4 cm 2 , p = 0.163), indexed aortic valve area (1.1 ± 0.6 vs. 1.0 ± 0.6, p = 0.337), peak transvalvular gradient (35.3 ± 20.5 vs. 39.1 ± 28.9 mm Hg, p = 0.862), and mean gradient (18.6 ± 12.3 vs. 22.7 ± 18.2 mm Hg, p = 0.571) and left ventricular ejection fraction (51.8 ± 11.6 vs. 51.8 ± 12.2%, p = 0.978) between type I and type II BAV groups.Conclusions: Type I BAV cusp fusion morphology is more commonly associated with dilatation of the aorta than type II, especially at the level of the sinus of Valsalva and the ascending aorta.

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Section: Aortic Dimensionsmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Bicuspid aortic valve morphology and its association with aortic diameter: an echocardiographic study

2016

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“…Initiated as a longitudinal population‐based survey of CV risk factors and CV disease in American Indians from 13 communities in Arizona, Oklahoma, and South and North Dakotas,14, 15, 16, 17 the Strong Heart Study was extended to members of large 3‐generation families (Strong Heart Family Study) during the fourth phase (between 2001 and 2003) 15, 16…”

Section: Methodsmentioning

confidence: 99%

“…A number of previous reports strongly suggest that age, sex, and body size are the most relevant variables to be considered when estimating whether or not AR is dilated 6, 9, 11, 12, 13, 14. Analyses taking into account the effect of these potent determinants might contribute to clarification of the interplay among ARD, components of BP, and flow output, a potential component of ARD variance that has been neglected.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic Correlates of Abnormal Aortic Root Dimension in an Adult Population: The Strong Heart Study

Simone

Roman

Marco

et al. 2015

JAHA

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BackgroundWe evaluated the relationship of aortic root dimension (ARD) with flow output and both peripheral and central blood pressure, using multivariable equations predicting ideal sex‐specific ARD at a given age and body height.Methods and ResultsWe measured echocardiographic diastolic ARD at the sinuses of Valsalva in 3160 adults (aged 42±16 years, 61% women) from the fourth examination of the Strong Heart Study who were free of prevalent coronary heart disease, and we compared measured data with the theoretical predicted value to calculate a z score. Central blood pressure was estimated by applanation tonometry of the radial artery in 2319 participants. ARD z scores were divided into tertiles representing small, normal, and large ARD. Participants with large ARD exhibited greater prevalence of central obesity and higher levels of inflammatory markers and lipids (0.05

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Association of Ascending Aortic Dilatation and Long-term Endurance Exercise Among Older Masters-Level Athletes

et al. 2020

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IMPORTANCE Aortic dilatation is frequently encountered in clinical practice among aging endurance athletes, but the distribution of aortic sizes in this population is unknown. It is additionally uncertain whether this may represent aortic adaptation to long-term exercise, similar to the well-established process of ventricular remodeling.OBJECTIVE To assess the prevalence of aortic dilatation among long-term masters-level male and female athletes with about 2 decades of exercise exposure. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study evaluated aortic size in veteran endurance athletes. Masters-level rowers and runners aged 50 to 75 years were enrolled from competitive athletic events across the United States from February to October 2018. Analysis began January 2019.EXPOSURES Long-term endurance exercise. MAIN OUTCOMES AND MEASURESThe primary outcome was aortic size at the sinuses of Valsalva and the ascending aorta, measured using transthoracic echocardiography in accordance with contemporary guidelines. Aortic dimensions were compared with age, sex, and body size-adjusted predictions from published nomograms, and z scores were calculated where applicable. RESULTS Among 442 athletes (mean [SD] age, 61 [6] years; 267 men [60%]; 228 rowers [52%]; 214 runners [48%]), clinically relevant aortic dilatation, defined by a diameter at sinuses of Valsalva or ascending aorta of 40 mm or larger, was found in 21% (n = 94) of all participants (83 men [31%] and 11 women [6%]). When compared with published nomograms, the distribution of measured aortic size displayed a rightward shift with a rightward tail (all P < .001). Overall, 105 individuals (24%) had at least 1 z score of 2 or more, indicating an aortic measurement greater than 2 SDs above the population mean. In multivariate models adjusting for age, sex, body size, hypertension, and statin use, both elite competitor status (rowing participation in world championships or Olympics or marathon time under 2 hours and 45 minutes) and sport type (rowing) were independently associated with aortic size. CONCLUSIONS AND RELEVANCEClinically relevant aortic dilatation is common among aging endurance athletes, raising the possibility of vascular remodeling in response to long-term exercise. Longitudinal follow-up is warranted to establish corollary clinical outcomes in this population.

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Reference Values for Echocardiographic Assessment of the Diameter of the Aortic Root and Ascending Aorta Spanning All Age Categories

Cited by 173 publications

References 27 publications

Bicuspid aortic valve morphology and its association with aortic diameter: an echocardiographic study

Bicuspid aortic valve morphology and its association with aortic diameter: an echocardiographic study

Hemodynamic Correlates of Abnormal Aortic Root Dimension in an Adult Population: The Strong Heart Study

Association of Ascending Aortic Dilatation and Long-term Endurance Exercise Among Older Masters-Level Athletes

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