Baseline Diameter Does Not Predict Growth Rate in a Presurgical Ascending Thoracic Aortic Aneurysm Population.

Autor: Marway PS; Department of Radiology University of Michigan Ann Arbor MI., Tjahjadi N; Department of Cardiac Surgery University of Michigan Ann Arbor MI., Campello Jorge CA; Department of Radiology University of Michigan Ann Arbor MI., Knauer H; Department of Radiology University of Michigan Ann Arbor MI., Spahlinger G; Department of Radiology University of Michigan Ann Arbor MI., Masotti M; Biostatistics, School of Public Health University of Michigan Ann Arbor MI., Eagle KA; Department of Internal Medicine-Cardiology University of Michigan Ann Arbor MI., Hofmann Bowman MA; Department of Internal Medicine-Cardiology University of Michigan Ann Arbor MI., Patel HJ; Department of Cardiac Surgery University of Michigan Ann Arbor MI., Burris NS; Department of Radiology University of Michigan Ann Arbor MI.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Oct 15; Vol. 13 (20), pp. e036896. Date of Electronic Publication: 2024 Oct 11.
DOI: 10.1161/JAHA.124.036896
Abstrakt: 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 ( r =0.02, P =0.74) or other aortic size metrics. On multivariate analysis, age was independently predictive of growth rate (β=-0.007, P =0.021), alongside weight (β=0.003, P =0.016) and the presence of moderate or severe aortic valve insufficiency (β=0.146, P =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).
Databáze: MEDLINE
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