Aortic Root Remodeling as an Indicator for Diastolic Dysfunction and Normative Ranges in Asians: Comparison and Validation with Multidetector Computed Tomography.

Lawrence Liu,Chung-Lieh Hung,Ta-Chuan Hung,Wen-Hung Huang,Cheng-Ting Tsai,Jui-Peng Tsai,Kuo-Tzu Sung,Jen-Yuan Kuo,Yueh-Hung Lin,Po-Jung Yuan,Cheng-Huang Su,Hung-I Yeh,Yau-Huei Lai,Ying-Ju Chen,Chun-Ho Yun

doi:10.3390/diagnostics10090712

Abstract

Background: The aortic root diameter (AoD) has been shown to be a marker of cardiovascular risk and heart failure (HF). Data regarding the normal reference ranges in Asians and their correlates with diastolic dysfunction using contemporary guidelines remain largely unexplored. Methods: Among 5343 consecutive population-based asymptomatic Asians with echocardiography evaluations for aortic root diameter (without/with indexing, presented as AoD/AoDi) were related to cardiac structure/function and N-terminal pro-brain B-type natriuretic peptide (Nt-ProBNP), with 245 participants compared with multidetector computed tomography (MDCT)-based aortic root geometry. Results: Advanced age, hypertension, higher diastolic blood pressure, and lower body fat all contributed to greater AoD/AoDi. The highest correlation between echo-based aortic diameter and the MDCT-derived measures was found at the level of the aortic sinuses of Valsalva (r = 0.80, p < 0.001). Age- and sex-stratified normative ranges of AoD/AoDi were provided in 3646 healthy participants. Multivariate linear regressions showed that AoDi was associated with a higher NT-proBNP, more unfavorable left ventricular (LV) remodeling, worsened LV systolic annular velocity (TDI-s′), a higher probability of presenting with LV hypertrophy, and abnormal LV diastolic indices except tricuspid regurgitation velocity by contemporary diastolic dysfunction (DD) criteria (all p < 0.05). AoDi superimposed on key clinical variables significantly expanded C-statistic from 0.71 to 0.84 (p for ∆AUROC: < 0.001). These associations were broadly weaker for AoD. Conclusion: In our large asymptomatic Asian population, echocardiography-defined aortic root dilation was associated with aging and hypertension and were correlated modestly with computed tomography measures. A larger indexed aortic diameter appeared to be a useful indicator in identifying baseline abnormal diastolic dysfunction.

Highlights

The aortic root diameter (AoD) gradually increases with age, which may parallel alterations of left ventricular (LV) geometry and diastolic function [1]
In our large population-based Asian cohort, we demonstrated that along with greater body surface area (BSA), increasing age, lower body fat fraction, and presence of HTN were markedly associated with larger aortic root size assessed at the level of the sinus of Valsalva
Conflicting data exist regarding the true impact of hypertension and systolic blood pressure on aortic root dilation [34,35,36], we did observe a consistent relationship between higher diastolic blood pressure and greater aortic diameter in our Asian population

Summary

Introduction

The aortic root diameter (AoD) gradually increases with age, which may parallel alterations of left ventricular (LV) geometry and diastolic function [1]. As it has been proposed that central pulse pressure is primarily determined by both aortic stiffness and aortic root geometry [8], a shorter body size though a greater indexed aortic size in ethnic Asians likely renders this population prone to augmented central hemodynamics from peripheral arterial wave reflections [9]. This may likely explain the observed racial differences in hypertension-related cardiovascular diseases [10]. Data regarding the normal reference ranges in Asians and their correlates with diastolic dysfunction using contemporary guidelines remain largely unexplored

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