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Individual, expected diameters of the ascending aorta and prevalence of dilations in a study-population aged 60–74 years: a DANCAVAS substudy

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Abstract

To determine individual, expected normal diameters of the ascending aorta (AAo) and prevalence of dilations based upon an absolute cut-off point (≥ 40 mm) and individual cut-off point (≥ 25% than expected normal). Non-contrast computed tomography (CT) scans were obtained in 14,993 individuals (95.0% male, mean age 67.8 ± 3.8). A sub-group (n = 291) had AAo diameter measured by transthoracic echocardiography. A prediction formula for AAo diameters was created from multivariate linear regression analysis based upon gender, age, and body surface area. An index was made by dividing observed diameters with predicted diameters. A size-index ≥ 1.25 was defined as dilated. Prevalence of AAo dilations among males and females using 40 mm as cut-off point were 10.6% and 2.1% (p < 0.001), respectively, while 3.3% and 2.6% (p = 0.305) using the size-index ≥ 1.25, respectively. Proportion of agreement between cases of AAo dilations from the size-index and 40 mm was 93.0%. Using the size-index as ‘golden standard’ for dilation, the sensitivity and specificity using 40 mm as cut-off point for males were 100.0% and 92.4%, respectively, while 75.0% and 99.9%, respectively, for females. For males and females, the positive predicted values were 31.3% and 93.8%, respectively; the negative predicted values were 100.0% and 99.3%, respectively. An absolute echocardiographic size-criterion of 40 mm entails a significant number of females with missed AAo dilation, and a large number of males are mistaken to have dilated AAo. Thus, AAo diameters should be evaluated in relation to gender, age and BSA. This study provides a formula for potential clinical implementation.

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Abbreviations

AAo:

Ascending aorta

CT:

Computed tomography

TTE:

Transthoracic echocardiography

BSA:

Body surface area

BMI:

Body mass index

BSA(d):

BSA calculated with Du Bois’ formula

BSA(m):

BSA calculated with Mosteller’s equation

ECG:

Electrocardiography-gated

DANCAVAS I + II:

The Danish Cardiovascular Multicenter Study I + II

References

  1. Coady MA, Rizzo JA, Hammond GL, Mandapati D, Darr U, Kopf GS et al (1997) What is the appropriate size criterion for resection of thoracic aortic aneurysms? J Thorac Cardiovasc Surg 113(3):476–491

    Article  CAS  Google Scholar 

  2. Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H et al (2014) 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 35(41):2873–2926

    Article  Google Scholar 

  3. Agarwal PP, Chughtai A, Matzinger FR, Kazerooni EA (2009) Multidetector CT of thoracic aortic aneurysms. Radiographics 29(2):537–552

    Article  Google Scholar 

  4. Burman ED, Keegan J, Kilner PJ (2008) Aortic root measurement by cardiovascular magnetic resonance: specification of planes and lines of measurement and corresponding normal values. Circ Cardiovasc Imaging 1(2):104–113

    Article  Google Scholar 

  5. Evangelista A, Flachskampf FA, Erbel R, Antonini-Canterin F, Vlachopoulos C, Rocchi G et al (2010) Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr 11(8):645–658

    Article  Google Scholar 

  6. Nienaber CA, Kische S, Skriabina V, Ince H (2009) Noninvasive imaging approaches to evaluate the patient with known or suspected aortic disease. Circ Cardiovasc Imaging 2(6):499–506

    Article  Google Scholar 

  7. Kerneis C, Pasi N, Arangalage D, Nguyen V, Mathieu T, Verdonk C et al (2018) Ascending aorta dilatation rates in patients with tricuspid and bicuspid aortic stenosis: the COFRASA/GENERAC study. Eur Heart J Cardiovasc Imaging 19(7):792–799

    Article  Google Scholar 

  8. Amsallem M, Ou P, Milleron O, Henry-Feugeas MC, Detaint D, Arnoult F et al (2015) Comparative assessment of ascending aortic aneurysms in Marfan patients using ECG-gated computerized tomographic angiography versus trans-thoracic echocardiography. Int J Cardiol 184:22–27

    Article  Google Scholar 

  9. Sperandio M, Arganini C, Bindi A, Fusco A, Olevano C, Bertoldo F et al (2013) The role of ECG-gated CT in patients with bicuspid aortic valve replacement: new perspectives in short- and long-term followup. ISRN Radiol 2013:826073

    Article  Google Scholar 

  10. Johnston KW, Rutherford RB, Tilson MD, Shah DM, Hollier L, Stanley JC (1991) Suggested standards for reporting on arterial aneurysms. Subcommittee on Reporting Standards for Arterial Aneurysms, Ad Hoc Committee on Reporting Standards, Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery. J Vasc Surg 13(3):452–458

    Article  CAS  Google Scholar 

  11. Devereux RB, de Simone G, Arnett DK, Best LG, Boerwinkle E, Howard BV et al (2012) Normal limits in relation to age, body size and gender of two-dimensional echocardiographic aortic root dimensions in persons >/=15 years of age. Am J Cardiol 110(8):1189–1194

    Article  Google Scholar 

  12. Kalsch H, Lehmann N, Mohlenkamp S, Becker A, Moebus S, Schmermund A et al (2013) Body-surface adjusted aortic reference diameters for improved identification of patients with thoracic aortic aneurysms: results from the population-based Heinz Nixdorf Recall study. Int J Cardiol 163(1):72–78

    Article  Google Scholar 

  13. Wolak A, Gransar H, Thomson LE, Friedman JD, Hachamovitch R, Gutstein A et al (2008) Aortic size assessment by noncontrast cardiac computed tomography: normal limits by age, gender, and body surface area. JACC Cardiovasc Imaging 1(2):200–209

    Article  Google Scholar 

  14. Diederichsen AC, Rasmussen LM, Sogaard R, Lambrechtsen J, Steffensen FH, Frost L et al (2015) The Danish Cardiovascular Screening Trial (DANCAVAS): study protocol for a randomized controlled trial. Trials 16:554

    Article  Google Scholar 

  15. Kvist TV, Lindholt JS, Rasmussen LM, Sogaard R, Lambrechtsen J, Steffensen FH et al (2017) The DanCavas Pilot Study of multifaceted screening for subclinical cardiovascular disease in men and women aged 65–74 years. Eur J Vasc Endovasc Surg 53(1):123–131

    Article  CAS  Google Scholar 

  16. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16(3):233–270

    Article  Google Scholar 

  17. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476):307–310

    Article  CAS  Google Scholar 

  18. Bland JM, Altman DG (1999) Measuring agreement in method comparison studies. Stat Methods Med Res 8(2):135–160

    Article  CAS  Google Scholar 

  19. Du Bois D, Du Bois EF (1989) A formula to estimate the approximate surface area if height and weight be known. Nutrition 5(5):303–311

    PubMed  Google Scholar 

  20. Mosteller RD (1987) Simplified calculation of body-surface area. N Engl J Med 317(17):1098

    CAS  PubMed  Google Scholar 

  21. Obel LM, Diederichsen AC, Steffensen FH, Frost L, Lambrechtsen J, Busk M et al (2018) High proportions of coexisting aortic dilations call for total aortic scan. J Am Coll Cardiol 71(7):811–812

    Article  Google Scholar 

  22. de Vet HC, Terwee CB, Knol DL, Bouter LM (2006) When to use agreement versus reliability measures. J Clin Epidemiol 59(10):1033–1039

    Article  Google Scholar 

  23. Kottner J, Audige L, Brorson S, Donner A, Gajewski BJ, Hrobjartsson A et al (2011) Guidelines for reporting reliability and agreement studies (GRRAS) were proposed. J Clin Epidemiol 64(1):96–106

    Article  Google Scholar 

  24. Mensel B, Kuhn JP, Schneider T, Quadrat A, Hegenscheid K (2013) Mean thoracic aortic wall thickness determination by cine MRI with steady-state free precession: validation with dark blood imaging. Acad Radiol 20(8):1004–1008

    Article  Google Scholar 

  25. Turkbey EB, Jain A, Johnson C, Redheuil A, Arai AE, Gomes AS et al (2014) Determinants and normal values of ascending aortic diameter by age, gender, and race/ethnicity in the Multi-Ethnic Study of Atherosclerosis (MESA). J Magn Reson Imaging 39(2):360–368

    Article  Google Scholar 

  26. Biancari F, Lahtinen J, Heikkinen J (2012) Impact of ascending aortic wall thickness and atherosclerosis on the intermediate survival after coronary artery bypass surgery. Eur J Cardiothorac Surg 41(5):e94–e99

    Article  Google Scholar 

  27. Anderson RH (1989) Cardiac morphology. In: Julian DG, Camm AJ, Fox KM, Hall RJC, Poole-Wilson PA (eds) Diseases of the heart. Baillière Tindall, London, pp 1338–1362

    Google Scholar 

  28. Mohr-Kahaly S, Erbel R (1995) Advantages of biplane and multiplane transesophageal echocardiography for the morphology of the aorta. Am J Card Imaging 9(2):115–120

    CAS  PubMed  Google Scholar 

  29. Vriz O, Driussi C, Bettio M, Ferrara F, D’Andrea A, Bossone E (2013) Aortic root dimensions and stiffness in healthy subjects. Am J Cardiol 112(8):1224–1229

    Article  Google Scholar 

  30. Guo MH, Appoo JJ, Saczkowski R, Smith HN, Ouzounian M, Gregory AJ et al (2018) Association of mortality and acute aortic events with ascending aortic aneurysm: a systematic review and meta-analysis. JAMA Netw Open 1(4):e181281

    Article  Google Scholar 

  31. Elefteriades JA (2002) Natural history of thoracic aortic aneurysms: indications for surgery, and surgical versus nonsurgical risks. Ann Thorac Surg 74(5):S1877–S1880

    Article  Google Scholar 

  32. Wanhainen A, Verzini F, Van Herzeele I, Allaire E, Bown M, Cohnert T et al (2019) Editor’s choice—European Society for Vascular Surgery (ESVS) 2019 clinical practice guidelines on the management of abdominal aorto-iliac artery aneurysms. Eur J Vasc Endovasc Surg 57(1):8–93

    Article  Google Scholar 

  33. Lindholt JS, Vammen S, Juul S, Fasting H, Henneberg EW (2000) Optimal interval screening and surveillance of abdominal aortic aneurysms. Eur J Vasc Endovasc Surg 20(4):369–373

    Article  CAS  Google Scholar 

  34. McCarthy RJ, Shaw E, Whyman MR, Earnshaw JJ, Poskitt KR, Heather BP (2003) Recommendations for screening intervals for small aortic aneurysms. Br J Surg 90(7):821–826

    Article  CAS  Google Scholar 

  35. Collin J, Heather B, Walton J (1991) Growth rates of subclinical abdominal aortic aneurysms—implications for review and rescreening programmes. Eur J Vasc Surg 5(2):141–144

    Article  CAS  Google Scholar 

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Funding

This study was supported by The Region of Southern Denmark, Elitary Research Center of Individualized Medicine in Arterial Diseases (CIMA), Danish Council for Independent Research, The Danish Heart Foundation, Odense University Hospital and The Helse Foundation.

Author information

Authors and Affiliations

  1. Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Sdr. Boulevard 29, Indgang 20, Penthouse 2. sal, 5000, Odense C, Denmark

    Lasse M. Obel & Jes S. Lindholt

  2. Center of Individualized Medicine in Arterial Disease (CIMA), Odense University Hospital, Odense, Denmark

    Lasse M. Obel, Jes S. Lindholt & Axel C. P. Diederichsen

  3. Department of Cardiology, Odense University Hospital, Odense, Denmark

    Tina H. Leetmaa, Jordi S. Dahl, Jacob E. Møller & Axel C. P. Diederichsen

  4. Department of Cardiology, Vejle Hospital, Vejle, Denmark

    Flemming H. Steffensen & Martin Busk

  5. Department of Cardiology, Diagnostic Center, Regional Hospital Silkeborg, Silkeborg, Denmark

    Lars Frost & Grazina Urbonaviciene

  6. Department of Cardiology, Svendborg Hospital, Svendborg, Denmark

    Jess Lambrechtsen & Kenneth Egstrup

  7. Department of Medicine, Nykoebing Falster Hospital, Nykoebing Falster, Denmark

    Marek Karon

  8. Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark

    Oke Gerke

Authors
  1. Lasse M. Obel
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  2. Jes S. Lindholt
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Correspondence to Lasse M. Obel.

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Appendix: Baseline characteristics stratified by the population not having TTE performed and the study population undergoing TTE

Appendix: Baseline characteristics stratified by the population not having TTE performed and the study population undergoing TTE

 

Study population not undergoing TTE

Males undergoing TTE

P values

Number (N)

14,702

291

 

Male gender

14,237 (94.9%)

291 (100.0%)

 < 0.01

Age (yrs)

67.8 (± 3.8)

68.5 (± 2.6)

 < 0.01

BMI (kg/m2)

28.0 (± 4.4)

28.4 (± 4.0)

0.19

BSA (m2)

2.04 (± 0.2)

2.07 (± 0.2)

 < 0.01

Smoking

  

0.58

 Current

2,337 (16.0%)

51 (17.7%)

 

 Former

7,320 (50.0%)

147 (50.9%)

 

 Never

4,986 (34.1%)

91 (31.5%)

 

Known hypertension

6,455 (43.9%)

125 (43.0%)

0.79

Known diabetes

1,613 (11.0%)

29 (10.0%)

0.60

Statin treatment

4,862 (33.1%)

100 (34.4%)

0.61

Prior cardiovascular disease

   

 AMI

849 (5.8%)

18 (6.2%)

0.76

 Stroke

943 (6.4%)

15 (5.2%)

0.39

  1. Numbers are mean (± SD) or number of patients (% proportion)
  2. BMI body mass index, BSA body surface area, AMI acute myocardial infarction

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Obel, L.M., Lindholt, J.S., Leetmaa, T.H. et al. Individual, expected diameters of the ascending aorta and prevalence of dilations in a study-population aged 60–74 years: a DANCAVAS substudy. Int J Cardiovasc Imaging 37, 971–980 (2021). https://doi.org/10.1007/s10554-020-02081-3

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