Abstract
ObjectivesTo clarify the prevalence and risk factors of ascending aortic (AA) dilatation according to ESC 2014 guidelines.MethodsThis study included 1000 consecutive patients scheduled for diagnostic coronary artery computed tomographic angiography. AA diameter was retrospectively measured in 3 planes: sinus valsalva, sinotubular junction, and tubular part. The threshold for AA dilatation was set to > 40 mm which has been suggested as an upper normal limit for AA diameter in ESC 2014 guidelines on aortic diseases. Aortic size index (ASI) using the ratio between aortic diameter and body surface area (BSA) was applied as a comparative measurement. The threshold for AA dilatation was set to the upper limit of normal distribution exceeding two standard deviations (95%). Risk factors for AA dilatation were collected from medical records.ResultsThe patients’ mean age was 52.9 ± 9.8 years (66.5% women). The prevalence of AA dilatation was 23.0% in the overall study population (52.5% males) and 15.1% in the subgroup of patients with no coronary artery disease or bicuspid (BAV)/mechanical aortic valve (n = 365). According to the normal-distributed ASI values, the threshold for sinus valsalva was defined as 23.2 mm/m2 and for tubular part 22.2 mm/m2 in the subgroup. Higher BSA was associated with larger AA dimensions (r = 0.407, p < 0.001). Male gender (p < 0.001), BAV (p < 0.001), hypertension (p = 0.009) in males, and smoking (p < 0.001) appeared as risk factors for AA dilatation.ConclusionsThe prevalence of AA dilatation is high with current ESC guidelines for normal AA dimension, especially in males. Body size is strongly associated with AA dimensions; it would be more reliable to use BSA-adjusted AA diameters for the definition of AA dilatation.Key Points• The prevalence of AA dilatation is high in patients who are candidates for coronary CT angiography.• Body size is strongly associated with AA dimensions.
Highlights
The European Society of Cardiology (ESC) guidelines suggest normal ascending aortic (AA) dimensions to be 40 mm or less in healthy adults
Body size is strongly associated with AA dimensions
The aim of this study was to determine the prevalence of AA dilatation according to ESC 2014 guidelines and to clarify AA dilatation risk factors in a consecutive single-center population scheduled for coronary computed tomography (CT) angiography (CCTA)
Summary
The European Society of Cardiology (ESC) guidelines suggest normal ascending aortic (AA) dimensions to be 40 mm or less in healthy adults. According to these criteria, patients with AA over 40 mm accompanied with risk factors should be monitored regularly either by computed tomography (CT) or magnetic resonance imaging (MRI) [1]. The bicuspid aortic valve (BAV) often causes valvular dysfunction (stenosis and regurgitation) and abnormal flow in the ascending aorta. BAV is associated strongly with TAD [8]. The prevalence of TAD has been reported to range from 30% up to even 70% in patients with BAV [12,13,14]
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