P2783Ascending aorta enlargement in patients referred to coronary artery calcium scoring

Abstract

Abstract Background Coronary artery calcium scoring is a main indication for a non-contrast-enhanced cardiac computed tomography (NCE-CCT). Great arterial vessels evaluation should be a part of CCT-based diagnosing. Purpose We aimed at analyzing data regarding great thoracic arterial sizes from a single-center cohort of 7950 patients who had NCE-CCT with a 64 raw scanner within the last decade. Methods In 5886 persons complete measurements of great arterial vessels' diameters at the level of the main pulmonary artery bifurcation were reported. The diameter of ascending aorta (AAD) was used to detect its enlargement on basis of absolute size, in relation to age and height (rAAD) and proportion to thoracic descending aorta (DAD) and main pulmonary artery (PAD). Respective criteria were: AAD≥43mm, rAAD>UNL for age/height (3.4+15.55*h+0.18*a), and AAD:DAD or AAD:PAD of 1.35 (range 1.1–1.6), both. Data were compared among patients with normal body mass index (BMI, kg/m2), overweight and obesity. Results Overall, increased absolute AAD was diagnosed in 149 persons (2.53%), rAAD>UNL in 358 (6.08%) and abnormal proportions AAD:DAD or AAD:PAD in 370 (13.0%) or 959 (16.3%), resp. Relative AAD was normal in 11 and 7 had normal proportions out of those with abnormal measured AAD. Among 138 patients with concordant absolute and relative increases, in 53 normal proportions were stated. In a cohort of 5737 patients with normal AAD (absolute), rAAD>UNL was found in 220 subjects (3.83%). Among remaining 5517 with normal both absolute and relative AAD, at least one abnormal proportion was found in 985 patients (17.9%). Taking into account BMI, the incidence of abnormal AAD was 0.3% in normal BMI patients (n=1409), 2,5% in overweight (n=2503) and 3.2% in obese (n=1974), while incidence of abnormal rAAD>UNL was 2.7%, 3.0% and 5.5%, resp. Abnormal proportions indicating abnormality within DAD or PAD were found in 1.1% and 3.8% normal BMI pts, in 2.4% and 4.7% overweight pts, and in 2.3% and 8.8% obese pts. Conclusions Absolute increase in ascending aorta size is relatively infrequent in patients referred to coronary artery calcium scoring. Use of age-height regression-based criteria increased diagnosis of abnormal ascending aorta size. Mutual proportions analysis among large arterial vessels showed further 5–6 fold increase in detection their abnormalities well before absolute or regression-based criteria are met. Great arterial vessels abnormalities are more frequent in overweight and obsese patients. Use of proportion analysis might be a step towards an individually-oriented medicine.