The aortic paradox: a nationwide analysis of 523 994 individual echocardiograms exploring fatal aortic dissection.

Autor:	Paratz ED; Heart, Exercise & Research Trials, Victor Chang Cardiac Research Institute, 405 Liverpool St, Darlinghurst, NSW 2010, Australia.; Heart, Exercise and Research Trials, St Vincent's Institute, 9 Princes St, Fitzroy, VIC 3065, Australia.; Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3000, Australia.; Ambulance Victoria, 31 Joseph St, Blackburn North, VIC 3130, Australia., Nadel J; Department of Cardiology, St Vincent's Hospital Sydney, 390 Victoria St, Darlinghurst, NSW 2010, Australia.; Heart Research Institute, 7 Eliza St, Newtown, NSW 2042, Australia., Humphries J; Advara HeartCare, Newdegate St, Greenslopes, QLD 4120, Australia.; Department of Cardiology, The Prince Charles Hospital, Rode Rd, Chermside, QLD 4032, Australia., Rowe S; Heart, Exercise & Research Trials, Victor Chang Cardiac Research Institute, 405 Liverpool St, Darlinghurst, NSW 2010, Australia.; Heart, Exercise and Research Trials, St Vincent's Institute, 9 Princes St, Fitzroy, VIC 3065, Australia.; Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3000, Australia., Fahy L; Heart, Exercise & Research Trials, Victor Chang Cardiac Research Institute, 405 Liverpool St, Darlinghurst, NSW 2010, Australia.; Heart, Exercise and Research Trials, St Vincent's Institute, 9 Princes St, Fitzroy, VIC 3065, Australia., La Gerche A; Heart, Exercise & Research Trials, Victor Chang Cardiac Research Institute, 405 Liverpool St, Darlinghurst, NSW 2010, Australia.; Heart, Exercise and Research Trials, St Vincent's Institute, 9 Princes St, Fitzroy, VIC 3065, Australia.; Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3000, Australia., Prior D; Heart, Exercise and Research Trials, St Vincent's Institute, 9 Princes St, Fitzroy, VIC 3065, Australia.; Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, VIC 3000, Australia., Celermajer D; Heart Research Institute, 7 Eliza St, Newtown, NSW 2042, Australia.; Department of Cardiology, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, NSW 2050, Australia.; Faculty of Medicine, University of Sydney, Camperdown, NSW 2050, Australia., Strange G; Department of Cardiology, The Prince Charles Hospital, Rode Rd, Chermside, QLD 4032, Australia.; Institute for Health Research, University of Notre Dame, 32 Mouat St, Fremantle, WA 6160, Australia., Playford D; Institute for Health Research, University of Notre Dame, 32 Mouat St, Fremantle, WA 6160, Australia.; School of Medicine, The University of Notre Dame, 32 Mouat St, Fremantle, WA 6160, Australia.
Jazyk:	angličtina
Zdroj:	European heart journal. Cardiovascular Imaging [Eur Heart J Cardiovasc Imaging] 2024 Sep 30; Vol. 25 (10), pp. 1423-1431.
DOI:	10.1093/ehjci/jeae140
Abstrakt:	Aims: Increasing aortic dilation increases the risk of aortic dissection. Nevertheless, dissection occurs at dimensions below guideline-directed cut-offs for prophylactic surgery. Currently, there are no large-scale population imaging data assessing aortic dimensions before dissection. Methods and Results: Patients within the National Echo Database of Australia were stratified according to absolute, height-indexed, and body surface area (BSA)-indexed aortic dimensions. Fatal thoracic aortic dissections (ICD-10-AM Code I71) were identified via linkage with the National Death Index. A total of 524 994 individuals were assessed, comprising patients with normal aortic dimensions (n = 460 992), mild dilation (n = 53 402), moderate dilation (n = 10 029), and severe dilation (n = 572). A total of 274 992 (52.4%) were males, with a median age of 64 years and a median follow-up time of 6.9 years. Eight hundred and ninety-nine fatal aortic dissections occurred (normal diameter = 610, mildly dilated aorta = 215, moderately dilated = 53, and severely dilated = 21). Using normal aortas as the reference population, odds of fatal dissection increased with aortic diameter [mild = odds ratio (OR) 3.05, 95% confidence interval (CI) 2.61-3.56; moderate = OR 4.0, 95% CI 3.02-5.30; severe = OR 28.72, 95% CI 18.44-44.72]. Due to the much larger number of patients without severe aortic dilation, 97.7% of fatal aortic dissections occurred in non-severely dilated aortas. Following sensitivity analysis, severe aortic dilation was responsible for at most 24.4% of fatal aortic dissections. The results were robust for absolute, height-indexed, or BSA-indexed aortic measurements. Conclusion: Although severe aortic dilatation is associated with a near-30-fold increase in fatal dissections, severely dilated aortas are implicated in only 2.3-24.4% of fatal dissections. This highlights the 'aortic paradox' and limitations of current guidelines. Future studies should seek to refine risk predictors in patients without severe aortic dilation. Competing Interests: Conflict of interest: None declared. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu