Thoracic Aortic Dimensions Research Articles

Application of Machine Learning Technology to Automate Thoracic Aorta Dimensions by Echocardiography

Application of Machine Learning Technology to Automate Thoracic Aorta Dimensions by Echocardiography

Coarctation of Aorta With Tricuspid Aortic Valve Is Not Associated With Ascending Aortic Aneurysm

BackgroundAortic aneurysm is common in patients with coarctation of aorta (COA), but it is unclear whether the risk of aortic aneurysms is due to COA or related to the presence of other risk factors such as bicuspid aortic valve (BAV) and hypertension. ObjectivesThe purpose of this study was to assess the relationship among COA, BAV, and thoracic aortic aneurysms. MethodsA total of 867 patients with COA (COA group) were matched 1:1:1 to 867 patients with isolated BAV (BAV group) and 867 patients without structural heart disease (SHD) (no-SHD group). The COA group was further subdivided into a COA+BAV subgroup (n = 304 [35%]), and COA with tricuspid aortic valve (TAV) (COA+TAV subgroup [n = 563 (65%)]). Aortic dimensions were assessed at baseline and at 3, 5, and 7 years. ResultsCompared with the no-SHD group, the COA+BAV subgroup had larger aortic root diameter (37 mm [Q1-Q3: 30-43 mm] vs 32 mm [Q1-Q3: 27-35 mm]; P < 0.001) and mid ascending aorta dimeter (34 mm [Q1-Q3: 29-40 mm] vs 28 mm [Q1-Q3: 24-31 mm]; P = 0.008). Similarly, the BAV group had larger aortic root diameter (37 mm [Q1-Q3: 30-42 mm] vs 32 mm [Q1-Q3: 27-35 mm]; P < 0.001), and mid ascending aorta dimeter (35 mm [Q1-Q3: 30-40 mm] vs 28 mm [Q1-Q3: 24-31 mm]; P < 0.001). Compared with the COA+TAV subgroup, the COA+BAV subgroup and BAV group were associated with larger aortic root and mid ascending aorta diameter at baseline and follow-up. The risk of acute aortic complications was low in all groups. ConclusionsThese findings suggest that BAV (and not COA) was associated with ascending thoracic aorta dimensions, and that patients with COA+TAV were not at a greater risk of developing ascending aortic aneurysms as compared with patients without SHD.

Association Between Vascular 18F-Fluorodeoxyglucose Uptake at Diagnosis and Change in Aortic Dimensions in Giant Cell Arteritis : A Cohort Study.

Previous studies have shown that patients with giant cell arteritis (GCA) who have vascular 18F-fluorodeoxyglucose (FDG) uptake at diagnosis are at increased risk for thoracic aortic complications. To measure the association between vascular FDG uptake at diagnosis and the change in aortic dimensions. Prospective cohort study. University Hospitals Leuven. 106 patients with GCA and FDG positron emission tomography (PET) imaging 3 days or less after initiation of glucocorticoids. Patients had PET and computed tomography (CT) imaging at diagnosis and CT imaging yearly for a maximum of 10 years. The PET scans were scored 0 to 3 in 7 vascular areas and summed to a total vascular score (TVS). The PET scan results were positive when FDG uptake was grade 2 or greater in any large vessel. The association between vascular FDG uptake and aortic dimensions was estimated by linear mixed-effects models with random intercept and slope. When compared with patients with a negative PET scan result, those with a positive scan result had a greater increase in the diameter of the ascending aorta (difference in 5-year progression, 1.58 mm [95% CI, 0.41 to 2.74 mm]), the diameter of the descending aorta (1.32 mm [CI, 0.38 to 2.26 mm]), and the volume of the thoracic aorta (20.5 cm³ [CI, 4.5 to 36.5 cm³]). These thoracic aortic dimensions were also positively associated with TVS. Patients with a positive PET scan result had a higher risk for thoracic aortic aneurysms (adjusted hazard ratio, 10.21 [CI, 1.25 to 83.3]). The lengthy inclusion and follow-up period resulted in missing data and the use of different PET machines. Higher TVS was associated with greater yearly increase in thoracic aortic dimensions. Performing PET imaging at diagnosis may help to estimate the risk for aortic aneurysm formation. None.

Estimation of thoracic aortic dimensions in smokers and non-smokers on Contrast-Enhanced Computed Tomography

Estimation of thoracic aortic dimensions in smokers and non-smokers on Contrast-Enhanced Computed Tomography

Prevalence and development of aortic dilation and dissection in women with Turner syndrome: a systematic review and meta-analysis

Objectives Women with Turner syndrome (TS) have an increased risk of aortic disease, reducing their life-expectancy. This study aimed to systematically review the prevalence of thoracic aortic dilatation, aortic dimensions and growth, and the incidence of aortic dissection in adult TS women. Methods A systematic literature search was conducted up to July 2022. Observational studies with an adult TS population were included, studies including children aged < 15 years old or a specific TS population were excluded. Results In total 21 studies were included. The pooled prevalence of ascending aortic dilatation was 23% (95%CI 19-26) at a mean pooled age of 29 years (95%CI 26-32), while the incidence of aortic dissection was 164 per 100.000 patient-years (95%CI 95-284). Three reporting studies showed aortic growth over time to be limited. Risk factors for aortic dilation or dissection were older age, bicuspid aortic valve, aortic coarctation and hypertension. Conclusion In adult women with TS, ascending aortic dilatation is common and the hazard of aortic dissection increased compared to the general population, whereas aortic growth is limited. Conventional risk markers do not explain all aortic dissection cases, therefore new imaging parameters and blood biomarkers are needed to improve prediction, allowing for patient-tailored follow-up and surgical decision making.

Is Thoracic Aortic Diameter an Independent Predictor of Cardiovascular Disease and Mortality? A Narrative Review.

Subclinical alterations in cardiac structure and function include a variety of abnormal phenotypes of recognized adverse prognostic values, such as left ventricular hypertrophy (LVH), concentric remodeling, systolic/diastolic dysfunction, left atrial dilatation, and alterations of LV geometry. The excess cardiovascular risk associated with these markers has been documented in multiple clinical settings, such as the general population, hypertensive cohorts, patients with coronary heart disease, diabetes mellitus, chronic heart failure, and chronic kidney disease. On the contrary, the value of aortic root (AR) and ascending aortic diameter in predicting cardiovascular outcomes and all-cause mortality in populations free from overt aortic pathology is still debated. The present review, aimed at pointing out the prognostic implications of thoracic aortic dimensions in populations free from known connective and aortic diseases, suggests that available evidence supporting an association between aortic diameter and cardiovascular events, and all-cause mortality is based on the limited number of studies, conducted with different imaging techniques and definition of the aortic phenotype.

Determinants of descending thoracic aortic size measured by echocardiography

Background: Aortic size is known to be an important predictor of cardiovascular diseases. There is a dearth of data on factors affecting thoracic aorta size in the black African population. Objective: To determine the predictors of descending thoracic aortic size measured by echocardiography. Materials and Methods: Transthoracic echocardiographic reports of 167 consecutive subjects were retrospectively reviewed. Data obtained from the register included age, gender, weight, height, body mass index, systolic blood pressure, diastolic blood pressure, and heart rate. Results: A total of 167 individuals aged between 12 and 96 years were studied. These were composed of 94 males and 73 females with mean age of 51.64 ± 16.31 and 46.90 ± 15.77, respectively. The mean descending thoracic aortic dimension was 23.35 ± 3.73 mm. The aortic measurement was found to be significantly higher in the male subjects (p < 0.05). A multi-variate correlation analysis revealed significant correlations between descending thoracic aortic dimension and (1) age, (2) weight, (3) body mass index, (4) systolic blood pressure, (5) diastolic blood pressure, (6) pulse pressure, and (6) mean arterial blood pressure (p < 0.05). These relationships were further explored using regression models. The most important predictors of aortic dimension in this study were age, weight, and sex (p < 0.05). Our result suggests a linear relationship between age and descending thoracic dimension. Conclusion: Age, body weight, and gender significantly affect the size of the descending thoracic aorta and could predict cardiovascular risk.

Multimodality imaging assessment of bicuspid aortic valve disease, thoracic aortic ectasia, and thoracic aortic aneurysmal disease.

Acute aortic syndromes have extremely high mortality rates and those with aortic dilation are at increased risk for these often catastrophic events. Serial monitoring of patients with aortic dilation is critical to determine the appropriate timing of preventative interventions. The thoracic aorta can be imaged and measured using multiple imaging modalities including transthoracic echocardiography, transesophageal echocardiography, multidetector cardiac computed tomography, and magnetic resonance imaging. There has not been agreement on the specific techniques that should be used to measure thoracic aortic dimensions with each imaging modality, leading to potential errors and challenges in comparing changes in measurements over time. It is critical to understand the current recommendations on thoracic aortic measurements for each imaging modality and cardiovascular imaging specialists need to be explicit about the methods that they have used to derive the thoracic aortic measurements. In those at high risk for aortic pathology, such as those with connective tissue diseases or bicuspid aortic valve, a multimodality imaging strategy incorporating echocardiography including three-dimensional measurements along with cardiac computed tomography or magnetic resonance imaging should be used to establish aortic dimensions and for continued monitoring to avoid progression to acute aortic syndromes.

Prevalence and Clinical Correlates of Aortic Dilation in Hypertrophic Cardiomyopathy

Aortic dilation has been associated with various cardiac conditions, although its prevalence and clinical correlates in hypertrophic cardiomyopathy (HCM) remain unclear. The purposes of this study were to define the prevalence of ascending aortic dilation in a large referral population of patients with HCM and to determine clinical and echocardiographic correlates of aortic dilation. A total of 1,698 patients with HCM underwent echocardiographic measurement of the tubular ascending aorta (proximal and midlevel) during index evaluation at a tertiary HCM referral center. End-diastolic ascending aorta dimension was indexed to body surface area, with dilation defined for the tubular ascending aorta as 2 SD above the mean (>19mm/m2) and independently as greater than published age-, sex-, and body surface area- adjusted norms (for the sinus of Valsalva and midlevel). Aortic size and presence of aortic enlargement were correlated with clinical and echocardiographic parameters. Tubular ascending aortic dilation >19mm/m2 was present in 303 patients with HCM (18%), and dilation above adjusted norms was present in 210 patients with HCM (13%). The median indexed tubular ascending thoracic aortic dimension was 16.5 (interquartile range, 14.8-18.2) mm/m2. Indexed dimension increased linearly with age (R=0.53, P<.0001). Women and patients with a history of systemic hypertension were more likely to have tubular aortic enlargement >19mm/m2 (29.8% vs 9.9% and 24.1% vs 10.5%, respectively, P<.0001 for both). Patients with obstructive physiology were more likely to have tubular aortic enlargement >19mm/m2 than those without resting or provocable obstruction (19.6% vs 14.4%, P=.007). Using adjusted norms, aortic enlargement was more frequent at the midlevel compared with the sinus of Valsalva (71% vs 29%), more common in patients with hypertension (15.4% vs 10.6%, P=.009), and more common in patients with paroxysmal atrial fibrillation (16.3% vs 11.5%, P=.036), but no other relationships remained statistically significant. In this large cohort of patients with HCM, aortic dilation was common. The key correlate of tubular aortic enlargement >19mm/m2, and aortic enlargement greater than adjusted norms included a history of systemic hypertension. Given an increased prevalence of aortic dilation in HCM, further study is needed on the clinical impact of aortic dilation.

Validation of thoracic aortic dimensions on ECG-triggered SSFP as alternative to contrast-enhanced MRA

ObjectivesAssessment of thoracic aortic dimensions with non-ECG-triggered contrast-enhanced magnetic resonance angiography (CE-MRA) is accompanied with motion artefacts and requires gadolinium. To avoid both motion artefacts and gadolinium administration, we evaluated the similarity and reproducibility of dimensions measured on ECG-triggered, balanced steady-state free precession (SSFP) MRA as alternative to CE-MRA.MethodsAll patients, with varying medical conditions, referred for thoracic aortic examination between September 2016 and March 2018, who underwent non-ECG-triggered CE-MRA and SSFP-MRA (1.5 T) were retrospectively included (n = 30). Aortic dimensions were measured after double-oblique multiplanar reconstruction by two observers at nine landmarks predefined by literature guidelines. Image quality was scored at the sinus of Valsalva, mid-ascending aorta and mid-descending aorta by semi-automatically assessing the vessel sharpness.ResultsAortic dimensions showed high agreement between non-ECG-triggered CE-MRA and SSFP-MRA (r = 0.99, p < 0.05) without overestimation or underestimation of aortic dimensions in SSFP-MRA (mean difference, 0.1 mm; limits of agreement, − 1.9 mm and 1.9 mm). Intra- and inter-observer variabilities were significantly smaller with SSFP-MRA for the sinus of Valsalva and sinotubular junction. Image quality of the sinus of Valsalva was significantly better with SSFP-MRA, as fewer images were of impaired quality (3/30) than in CE-MRA (21/30). Reproducibility of dimensions was significantly better in images scored as good quality compared to impaired quality in both sequences.ConclusionsThoracic aortic dimensions measured on SSFP-MRA and non-ECG-triggered CE-MRA were similar. As expected, SSFP-MRA showed better reproducibility close to the aortic root because of lesser motion artefacts, making it a feasible non-contrast imaging alternative.Key Points• SSFP-MRA provides similar dimensions as non-ECG-triggered CE-MRA.• Intra- and inter-observer reproducibilities improve for the sinus of Valsalva and sinotubular junction with SSFP-MRA.• ECG-triggered SSFP-MRA shows better image quality for landmarks close to the aortic root in the absence of cardiac motion.

Multimodality Assessment of Thoracic Aortic Dimensions: Comparison of Computed Tomography Angiography, Magnetic Resonance Imaging, and Echocardiography Measurements.

The purpose of this study was to compare thoracic aortic measurements between computed tomography (CT), magnetic resonance imaging (MRI), and transthoracic echocardiography (TTE). A total of 127 patients (mean age: 45±18 y, 49% male) who had undergone CT and MRI evaluation of the thoracic aorta at a single tertiary referral hospital within a 6-month interval between 2007 and 2017 were included in this retrospective study. TTE studies performed within the same 6-month interval were also evaluated. Thoracic aortic measurements were blindly evaluated using multiple techniques and were compared between modalities. There was no significant difference in maximum aortic root diameter between CT and MRI when using the inner lumen-to-inner lumen technique (mean difference: 0.2±1.4 mm, P=0.51) or the outer lumen-to-outer lumen technique (mean difference: 0.5±1.4 mm, P=0.07). There were no significant differences between CT and MRI at any other level except for the distal descending aorta (20.2±4.6 vs. 19.8±4.6 mm, P<0.001). However, aortic root measurements by TTE using the leading edge-to-leading edge technique were significantly smaller compared with maximum aortic root diameters using the inner lumen-to-inner lumen and outer lumen-to-outer lumen techniques by both CT (mean difference: 4.9±2.7 mm, P<0.001 and 7.4±2.8 mm, P<0.001, respectively) and MRI (mean difference: 4.8±3.2 mm, P<0.001 and 8.2±3.0 mm, P<0.001, respectively). There is excellent agreement in thoracic aortic measurements between CT and MRI. However, TTE significantly underestimates maximum aortic root diameter compared with CT and MRI. Therefore, caution should be used when interpreting small apparent changes in aortic root diameters between TTE and CT or MRI.

Identification of cardiac organ damage in arterial hypertension: insights by echocardiography for a comprehensive assessment.

: Arterial hypertension, a widespread disease, whose prevalence increases with age, represents a major risk factor for cardiovascular events, causing damage in several organs, including the heart. In this context, echocardiography has a clear and pivotal role, being able to assess cardiac morphology and detect haemodynamic changes induced by this disease. 2018 European Society of Cardiology/European Society of Hypertension guidelines on AH identified main echo parameters such as left ventricular mass, relative wall thickness and left atrial volume, for detecting cardiac organ damage. The present review highlights the advantage of additional echocardiographic parameters such as diastolic measurement and both thoracic and abdominal aortic dimensions. An overlook on aortic valve should also be suggested to detect aortic regurgitation and stenosis, both frequent complications in hypertensive patients. In this kind of comprehensive assessment, the combination of standard and advanced echocardiography (speckle tracking echocardiography and, with a lesser extent, three-dimensional echocardiography) could be considered to improve the diagnostic accuracy, stratify prognosis and address management in arterial hypertension.

Simplified Rapid Protocol for Assessing the Thoracic Aortic Dimensions and Pathology with Noncontrast MR Angiography.

Contrast enhanced magnetic resonance angiography (CE-MRA) is limited by long acquisition time and contrast exposure in aortic emergencies. To compare the effcacy of dark blood (DB) and bright blood (BB) noncontrast sequences with the gold standard CE-MRA using a novel protocol for performing consistent thoracic aortic measurements and thoracic aortic pathologies identifications. A total of 66 patients with suspected or known thoracic aortic pathology who underwent CE-MRA underwent DB and BB imaging prior to CE-MRA for planning purposes. Aortic dimension was measured at 10 standard reference points in the ascending, arch, and descending aorta. Detection of aortic pathologies was recorded individually for each noncontrast sequence. When comparing the CE-MRA to the DB images and CE-MRA to the BB images, a majority of the measurement differences were less than or equal to 2 mm or resulted in no change of diagnostic class (95% for CE-MRA vs. DB and 96% for CE-MRA vs. BB). Of the patients who had major changes in diagnostic class (e.g., changes in two or three classes), the absolute measurements were not clinically significant in any given patient to warrant a change in management. Individually, the DB and BB sequences allowed for accurate recognition of all 47 aortic pathologies. DB and BB sequences produced comparable and consistent measurements of the thoracic aorta when compared with CE-MRA. In a situation where CE-MRA is not readily available or contraindicated, noncontrast MRA using our protocol is a reliable alternative to CE-MRA for assessment of aortic pathologies.

Bicuspid aortic valve outcomes.

Bicuspid aortic valve is the most common CHD. Its association with early valvular dysfunction, endocarditis, thoracic aorta dilatation, and aortic dissection is well established. The aim of this study was to assess the incidence and predictors of cardiac events in adults with bicuspid aortic valve. We carried out a retrospective analysis of cardiac outcomes in ambulatory adults with bicuspid aortic valve followed-up in a tertiary hospital centre. Outcomes were defined as follows: interventional - intervention on the aortic valve or thoracic aorta; medical - death, aortic dissection, aortic valve endocarditis, congestive heart failure, arrhythmias, or ischaemic heart disease requiring hospital admission; and a composite end point of both. Kaplan-Meier curves were generated to determine event rates, and predictors of cardiac events were determined by multivariate analysis. A total of 227 patients were followed-up over 13±9 years; 29% of patients developed severe aortic valve dysfunction and 12.3% reached ascending thoracic aorta dimensions above 45 mm. At least one cardiac outcome occurred in 38.8% of patients, with an incidence rate at 20 years of follow-up of 47±4%; 33% of patients were submitted to an aortic valve or thoracic aorta intervention. Survival 20 years after diagnosis was 94±2%. Independent predictors of the composite end point were baseline moderate-severe aortic valve dysfunction (hazard ratio, 3.19; 95% confidence interval, 1.35-7.54; p<0.01) and aortic valve leaflets calcification (hazard ratio, 4.72; 95% confidence interval, 1.91-11.64; p<0.005). In this study of bicuspid aortic valve, the long-term survival was excellent but with occurrence of frequent cardiovascular events. Baseline aortic valve calcification and dysfunction were the only independent predictors of events.

Reference Values for Cardiac and Aortic Magnetic Resonance Imaging in Healthy, Young Caucasian Adults.

BackgroundReference values for morphological and functional parameters of the cardiovascular system in early life are relevant since they may help to identify young adults who fall outside the physiological range of arterial and cardiac ageing. This study provides age and sex specific reference values for aortic wall characteristics, cardiac function parameters and aortic pulse wave velocity (PWV) in a population-based sample of healthy, young adults using magnetic resonance (MR) imaging.Materials and MethodsIn 131 randomly selected healthy, young adults aged between 25 and 35 years (mean age 31.8 years, 63 men) of the general-population based Atherosclerosis-Monitoring-and-Biomarker-measurements-In-The-YOuNg (AMBITYON) study, descending thoracic aortic dimensions and wall thickness, thoracic aortic PWV and cardiac function parameters were measured using a 3.0T MR-system. Age and sex specific reference values were generated using dedicated software. Differences in reference values between two age groups (25–30 and 30–35 years) and both sexes were tested.ResultsAortic diameters and areas were higher in the older age group (all p<0.007). Moreover, aortic dimensions, left ventricular mass, left and right ventricular volumes and cardiac output were lower in women than in men (all p<0.001). For mean and maximum aortic wall thickness, left and right ejection fraction and aortic PWV we did not observe a significant age or sex effect.ConclusionThis study provides age and sex specific reference values for cardiovascular MR parameters in healthy, young Caucasian adults. These may aid in MR guided pre-clinical identification of young adults who fall outside the physiological range of arterial and cardiac ageing.

Proximal thoracic aorta dimensions after continuous-flow left ventricular assist device implantation: Longitudinal changes and relation to aortic valve insufficiency

In this study we examined the impact of continuous-flow left ventricular assist device (CF-LVAD) support on proximal thoracic aorta dimensions. Aortic root and ascending aorta diameter were measured from serial echocardiograms before and after CF-LVAD implantation in patients with ≥6 months of support, and correlated with the development of >mild aortic valve insufficiency (AI). Of 162 patients included, mean age was 58 ± 11 years and 128 (79%) were male. Seventy-nine (63%) were destination therapy patients. Mean aortic root and ascending aorta diameters at baseline, 1 month, 6 months, 12 months and long-term follow-up (mean 2.0 ± 1.4 years) were 3.5 ± 0.4, 3.5 ± 0.3, 3.9 ± 0.3, 3.9 ± 0.2 and 4.0 ± 0.3, and 3.3 ± 0.2, 3.3 ± 0.3, 3.6 ± 0.2, 3.6 ± 0.3 and 3.6 ± 0.3 cm, respectively. Only change in aortic root diameter from 1-month to 6-month follow-up reached statistical significance (p = 0.03). Nine (6%) patients had accelerated proximal thoracic aorta expansion (>0.5 cm/year), occurring predominantly in the first 6 months after implantation. These patients were older and more likely to have hypertension and baseline proximal thoracic aorta dilation. Forty-five (28%) patients developed >mild AI at long-term follow-up, including 7 of 9 (78%) of those with accelerated proximal thoracic aorta expansion. All 7 had aortic valves that remained closed throughout the cardiac cycle, and this, along with duration of CF-LVAD support and increase in aortic root diameter, were significantly associated with developing >mild AI. CF-LVAD patients have small increases in proximal thoracic aorta dimensions that predominantly occur within the first 6 months after implantation and then stabilize. Increasing aortic root diameter was associated with AI development.

Aortic valve and aortic root features in CT angiography in patients considered for aortic valve repair

BackgroundThe underlying mechanism of aortic regurgitation and aortic valve and root characteristics are associated with the durability of surgical repair. ObjectiveWe investigated whether multidetector CT (MDCT) identifies the characteristics of the aortic valve and root that may be associated with the ability to perform successful surgical repair. MethodsSixty-one patients with aortic regurgitation and/or aortic root pathology who were evaluated for aortic valve or root repair and underwent clinically indicated gated or nongated MDCT of the aortic valve and aortic root were included in the present analysis. Patients with endocarditis were excluded. MDCT data of aortic valve anatomy and calcification and thoracic aorta dimensions were analyzed. ResultsThe aortic valve and root was successfully repaired in 36 patients (55 ± 13 years; 61% male; median EuroSCORE II, 3.8%) whereas in 25 patients (56 ± 15 years; 52% male; median EuroSCORE II, 2.5%) repair was not attempted (n = 20) or valve repair was converted to aortic valve replacement during surgery (n = 5). In patients in whom repair was considered not possible or failed, there was a higher percentage of bicuspid aortic valves (48% vs 17%; P = .019), more severe commissural calcification, and more severe annular calcification. ConclusionThe degree of commissural and annular calcification of the aortic valve determined by MDCT is inversely related to the ability to perform surgical valve repair instead of replacement. Similarly, bicuspid valve anatomy predicts failure to perform repair.

Correlation between congenital bicuspid aortic valve morphology with thoracic aortic dimensions - a retrospective analysis with cardiovascular magnetic resonance

Background Congenital bicuspid aortic valve (BAV) is the commonest inherited cardiac defect that is often associated with a medley of other cardiovascular anomaly, the most frequent being aortic dilatation which may be a consequent of an interplay between genetic and hemodynamic factors. This retrospective study aims to find a correlation between BAV valve morphology with thoracic aortic dimension with cardiovascular magenetic resonance imaging (CMR). Methods A retrospective analysis of the aortic valve and aortic (Ao) dimension was made of 149 patients aged between 6 and 77 years (mean age 43±17 ,102 males and 47 females) with BAV who underwent CMR study. BAV patients with associated coarctation or valvular dysfunction were excluded. Images were acquired with either a Siemens Avanto or Sonata 1.5T scanner in orthogonal planes. Aortic maximal intraluminal dimensions in end diastole were measured at the annulus, sinuses, sino-tubular junction, mid ascending aorta, arch and proximal descending aorta. These measurements were indexed according to body surface area (BSA). BAV valve morphology were characterised in cross-sectional steadystate free precession (SSFP) cine images and grouped according to the presence or absence of a raphe. Results Of the valve morphology, majority of patients (59.7%) had a raphe, almost always seen between the fused right and left cusps (89%). The indexed aortic root and ascending aortic dimensions were found to be smaller in patients with remnant raphe BAV as compared with those without a raphe (‘pure’ BAV). There was a trend towards smaller

Periaortic Adipose Tissue and Aortic Dimensions in the Framingham Heart Study

BackgroundPeriaortic fat, because of its contiguity with the aorta, may promote vascular remodeling and aortic dilatation. However, the relations between perioartic fat depots and aortic dimensions have not been previously described.Methods and ResultsA total of 3001 individuals (mean age 50±10 years, 49% women) from the Framingham Offspring and Third Generation cohorts underwent computed tomography for quantification of periaortic fat and aortic dimensions. We estimated the association between quantitative periaortic and visceral adipose tissue volumes (per standard deviation [SD] increment of volume) with aortic dimensions in both the thorax and abdomen. Thoracic periaortic fat was associated with higher thoracic aortic dimensions (β coefficient per SD of fat volume 0.67 mm, 95% confidence interval 0.58 to 0.76 mm; P<0.001). The association persisted after adjustment for age, sex, and cardiovascular risk factors including body mass index and visceral adipose tissue volume. Results for the association of periaortic fat and abdominal aortic dimensions were similar. Further adjustment for adipokines (resistin and adiponectin) had no significant impact on these associations.ConclusionsPeriaortic fat volume was associated with aortic dimensions in both the thorax and abdomen, supporting the notion that local fat depots may contribute to aortic remodeling. Further work to understand the mechanisms underlying this association is warranted.

Abstract 277: The Relationship Between Aortic And PA Diameter Among Individuals With Genetic Conditions Of The Thoracic Aorta: A Report From The NIH Gentac Registry

Background The aorta and pulmonary artery (PA) share structural similarities, and thus genetic conditions affecting the thoracic aorta may also affect the PA. We evaluated the relationship between aortic and pulmonary artery dimensions on chest CT among a subset of participants in the Genetically Triggered Thoracic Aortic Aneurysms and Cardiovascular Conditions Registry (GenTAC). Methods Data Adults in GenTAC without a history of aortic surgery or aortic dissection (N = 144) and with computed tomography of the chest were included. Standardized double oblique measurements of the pulmonary artery, and thoracic aortic dimensions at 8 sites (sinus of Valsalva through the suprarenal aorta) were measured in a core laboratory. The relationship between the PA and aortic dimensions were analyzed using bivariate correlations, and multivariable linear regression controlling for age and body size. Results Mean age was 45±13 years. The mean maximum ascending aortic dimension was 3.8±0.9 cm (range 2.4-7.9 cm); mean PA dimension was 3.1±0.5 cm (1.8-4.8 cm). Using a cutoff of 2.8 cm defining the 90 th percentile value for PA diameter, 65% of the study population had dilated PA. Correlations between the aortic and pulmonary artery diameter were higher for the descending aorta than the ascending aorta. The highest observed correlation between PA and aortic diameter was observed for the thoracoabdominal aorta at the level of the diaphragm (r = 0.40; P &lt;0.001). In a linear regression model evaluating relationships between PA diameter and various aortic segments, after controlling for age and body size, the PA and descending thoracic aorta were independently related (partial correlation r = 0.28; P&lt;0.001). Similar relationships were not observed for the ascending aorta. Conclusions A dilated PA is common among individuals with genetically-associate thoracic aortic dilatation. The diameter of the PA relates modestly to aortic dimensions, most strongly with the descending thoracic aorta.