Author + information
- Thais Coutinhoa,b,
- Katie Y. Cheunga,b,
- Munir Boodhwania,b,
- Luc Beauchesnea,b,
- Carole Denniea,b,
- Alexander Dicka,b,
- Sudhir Nagpala,b and
- Kwan-Leung Chana,b
Background: Women with thoracic aortic aneurysms (TAAs) have greater risk of acute aortic syndromes and death than men. We have previously shown that women have faster TAA growth than men, which helps explain the worse TAA outcomes in women. To explore mechanisms leading to faster TAA growth in women, we sought to determine the sex-specific role of aortic stiffness on TAA growth.
Methods: One hundred unoperated subjects with TAA were recruited. Maximal aneurysm size at the oldest and latest imaging studies was measured; aneurysm growth rate was calculated and indexed to body surface area to correct aneurysm size for body size (iAGR). Aortic stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV) using applanation tonometry. Stepwise multivariable linear regression (P≤0.25 to enter, P≤0.10 to stay in the model) was performed to assess the association of cfPWV with iAGR. Covariates considered in the models were: age, aneurysm location, baseline aneurysm size, time between studies, aneurysm etiology, mean arterial pressure, hypertension, diabetes, smoking, and anti-hypertensive use. We also tested the interaction term sex*cfPWV in the prediction of TAA growth.
Results: Seventy four percent of subjects were men. Mean±SD age, baseline aneurysm size and follow-up time were 63.4±11.7 years, 45.4±4.1 mm and 3.2±3.0 years, respectively, and not different based on sex. cfPWV was 10.4±4.5 m/s women and 9.7±3.5 m/s in men (P=0.45). iAGR was 0.63±0.61 (mm/year)/m2 in women and 0.25±0.30 (mm/year)/m2 in men (P=0.005). In the whole group, cfPWV was not independently associated with iAGR (β±SE: 0.02±0.01, P=0.13). However, in sex-specific analyses cfPWV was independently associated with faster aneurysm growth in women (β±SE: 0.16±0.05, P=0.002), but not in men (β±SE: -0.00006±0.10, P=0.99), with a significant sex*cfPWV interaction (P=0.001).
Conclusions: In patients with TAA, aneurysm growth was more than twice as fast in women than men, and aortic stiffness was associated with greater TAA growth in women, but not in men. Since aneurysm growth is an important risk factor for acute aortic syndromes, our findings highlight potential mechanisms predisposing to worse TAA-related outcomes in women.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Vascular Medicine: New Insights Into Aortic and Peripheral Artery Diseases
Abstract Category: 40. Vascular Medicine: Non Coronary Arterial Disease
Presentation Number: 1128-352
- 2017 American College of Cardiology Foundation