Transthoracic echocardiographic reference values of the aortic root: results from the Hamburg City Health Study

Jan-Per Wenzel,Matthias Theissen,Julius Nikorowitsch,Elina Petersen,Hermann Reichenspurner,Evaldas Girdauskas,Christoph Sinning,Johannes Petersen,Juliana Senftinger

doi:10.1007/s10554-021-02354-5

Abstract

Here we generate up-to-date reference values of transthoracic echocardiographic aortic root dimensions matched by sex, age, and body surface area (BSA) derived from the population-based Hamburg City Health Study (HCHS) cohort. In 1687 healthy subjects (mean age 57.1 ± 7.7, 681 male and 1006 female), derived from the first prospectively-recruited 10,000 HCHS participants, dimensions of the aortic root were measured in systole and diastole using state-of-the-art 2-dimensional transthoracic echocardiography. Diameters were assessed at four levels: aortic annulus, Sinus of Valsalva, sinotubular junction, and ascending aorta. Female sex was associated with significantly smaller absolute aortic root dimensions, while indexing for BSA resulted in a reverse effect at all levels. There was a strong age dependency of all aortic root diameters as well as aortic annulus/sinotubular junction ratio for both sexes. Multivariate analysis revealed age, sex, weight, height, and BSA to be significant determinants of aortic root size. Finally, formulas were generated for the calculation of individual aortic root reference values considering age, sex, weight, and height. We provide population-based reference values of aortic root diameters based on a standardized transthoracic echocardiographic protocol of the population-based HCHS which may support the diagnosis, monitoring, and treatment of aortic root disease.

Highlights

Aortic root dilatation is a common and multifactorial condition influenced by genetics, hemodynamic-rheological factors, and comorbidities [1]
Based on the inclusion of a sample of the first 10,000 Hamburg City Health Study (HCHS) study participants, the present study aims to define 2-dimensional Transthoracic echocardiography (TTE) aortic root reference values derived from a standardized echocardiographic protocol adjusted for age, sex, height, weight, and body surface area (BSA)
Continuous variables are presented as mean and standard deviation, and categorical variables are presented as absolute numbers and percentages

Summary

Introduction

Aortic root dilatation is a common and multifactorial condition influenced by genetics, hemodynamic-rheological factors, and comorbidities [1]. Transthoracic echocardiography (TTE) is the most commonly used imaging modality to evaluate the aortic root in the daily clinical practice. This is predominantly due to its wide availability, non-invasiveness, ease of use, and reproducibility. Echocardiographic screening, grading, and surveillance of aortic root aneurysms has a major impact on the patient care. The assessment of the aortic root is highly dependent on the acoustic window, proper alignment, the exact location of measurements as well as the availability of validated reference values. Most of the previously published aortic root reference studies are potentially biased by limited sample sizes, heterogenous measuring techniques and selective study populations [6,7,8,9]

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Results

Conclusion