Aortic root dimensions as a correlate for aortic regurgitation\u2019s severity

Jan-Per Wenzel,Julius Nikorowitsch,Stefan Blankenberg,Elina Petersen,Jessica Müller,Tilo Kölbel,Evaldas Girdauskas,Hermann Reichenspurner

doi:10.1007/s10554-021-02337-6

Abstract

To evaluate the prevalence of aortic regurgitation (AR) and associations between the individual aortic root components and AR severity in the general population. The study included the first 10,000 participants of the population-based Hamburg City Health Study (HCHS) of whom 8259 subjects, aged 62.23 ± 8.46 years (51.3% females), enrolled 2016–2018, provided echocardiographic data. 69 subjects with bicuspid valves and 23 subjects with moderate/severe aortic stenosis were excluded. Aortic root dimensions were measured using state-of-the-art cardiac ultrasound, including the aortic annulus, sinus of Valsalva, sinotubular junction (STJ), and ascending aorta, in diastole and systole. The distribution of AR was: 932 (11.4%) mild, 208 (2.5%) moderate, and 20 (0.24%) severe. Patients with moderate or severe AR were predominantly male at advanced age who had hypertension, coronary artery disease, atrial fibrillation, and renal dysfunction. Increasing AR severity correlated with higher absolute and indexed aortic root diameters (e.g., end-diastolic sinus of Valsalva for no-mild-moderate-severe AR in mm ± standard deviation: 34.06 ± 3.81; 35.65 ± 4.13; 36.13 ± 4.74; 39.67 ± 4.61; p < 0.001). In binary logistic regression analysis, all aortic root components showed significant associations with moderate/severe AR. Mid-systolic STJ showed the strongest association with moderate/severe AR (OR 1.33, 95% confidence interval 1.25–1.43, p < 0.001). AR was prevalent in 14.2%, of whom 2.8% showed moderate/severe AR. All assessed aortic root diameters correlated with the prevalence and severity of AR. STJ diameter had the strongest association with moderate/severe AR possibly reflecting the pathophysiological impact of an increasingly dilated STJ in the context of an ageing aorta.

Highlights

The aortic root is a complex and dynamic entity, varying in size proportionally to height, weight, and age
Little is known about the role of the individual components of the aortic root and their timepoint of measurement during the heart cycle in relation to aortic regurgitation (AR), which is crucial to understand in the field of aortic valve (AV) repair surgery
Echocardiography revealed slightly lower left ventricular systolic function and larger left-sided cavities as well as a higher E/e’ ratio in subjects with moderate/severe AR compared to subjects without AR (Table 2). 7 subjects suffered from moderate/severe AR combined with mild AS

Summary

Introduction

The aortic root is a complex and dynamic entity, varying in size proportionally to height, weight, and age. Along with a dramatic decrease of rheumatic heart disease in the Western world, aortic root dilatation evolved into the predominant cause of aortic regurgitation (AR) [1,2,3,4]. AR is a multifactorial valvular disease and the correlation between the extent of aortic root dilatation and the severity of AR remains controversial [2, 3]. Little is known about the role of the individual components of the aortic root and their timepoint of measurement during the heart cycle in relation to AR, which is crucial to understand in the field of AV repair surgery. Given major improvements in spatial and temporal resolution of 2-dimensional and color Doppler transthoracic echocardiography (TTE), most previous studies investigating AR prevalence and its correlation with aortic root diameter are rather outdated [2, 5,6,7]

Objectives

Methods

Results

Discussion

Conclusion