AI Article Synopsis
- - The study investigates the relationship between the size of ascending thoracic aortic aneurysms and their growth rates, utilizing a precise technique called vascular deformation mapping for measurement.
- - Researchers analyzed data from 258 patients (average age 63) with aneurysm diameters of at least 4.0 cm and found that the maximal diameter of the aorta does not correlate with the growth rate, which averaged 0.21 mm/year.
- - Factors like age, weight, and the severity of aortic valve insufficiency were identified as significant predictors of growth rate, suggesting that routine size assessments alone may not adequately determine surgical candidacy.
Article Abstract
Background: Patients with ascending thoracic aortic aneurysm are recommended to undergo routine imaging surveillance. Although maximal diameter is the primary metric of disease severity, recent American College of Cardiology/American Heart Association guidelines emphasize the importance of aortic growth in determining surgical candidacy and risk. As diameter increases, it is assumed that aortic growth rate accelerates because of increased wall tension; however, this relationship is poorly studied. We aim to investigate the relationship between ascending thoracic aortic aneurysm diameter and growth rate using vascular deformation mapping, a validated technique for 3-dimensional growth mapping with submillimeter accuracy.
Methods And Results: We retrospectively identified adult patients with ascending aortic dilation (≥4.0 cm) and serial gated computed tomography angiograms separated by ≥2 years, excluding confirmed heritable thoracic aortic disease. Ascending growth rate was defined as 90th percentile radial wall deformation by vascular deformation mapping. Maximal diameter measurements were derived from the baseline computed tomography angiogram, and aortic length and body size-adjusted indexes were calculated. Among 258 included patients (63.2% men; age of 63 years [interquartile range, 55-69 years]), mean±SD baseline diameter was 46.3±3.6 mm and median growth rate was 0.21 mm/year (interquartile range, 0.13-0.38 mm/year). No correlation was noted between growth rate and baseline diameter (=0.02, =0.74) or other aortic size metrics. On multivariate analysis, age was independently predictive of growth rate (β=-0.007, =0.021), alongside weight (β=0.003, =0.016) and the presence of moderate or severe aortic valve insufficiency (β=0.146, =0.049).
Conclusions: Maximal aortic diameter is not predictive of aortic growth rate, in this contemporary cohort of patients with sizes under current surgical thresholds (<55 mm).
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| http://dx.doi.org/10.1161/JAHA.124.036896 | DOI Listing |
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