Author + information
- Received June 1, 2019
- Revision received July 24, 2019
- Accepted July 28, 2019
- Published online October 7, 2019.
- Jinlin Wu, MDa,b,∗@jinlinhorsy,
- Mohammad A. Zafar, MDa,∗@MohammadAZafar,
- Yupeng Li, PhDc,
- Ayman Saeyeldin, MDa,
- Yan Huang, MDd,
- Rui Zhao, MDb,
- Juntao Qiu, MDb,
- Maryam Tanweer, MDa,
- Mohamed Abdelbaky, MDa,
- Anton Gryaznov, MDa,
- Joelle Buntin, MSN, RN, RN-BCa,
- Bulat A. Ziganshin, MD, PhDa,e,
- Sandip K. Mukherjee, MDa,
- John A. Rizzo, PhDf,
- Cuntao Yu, MDb,∗ ( and )
- John A. Elefteriades, MD, PhD (Hon)a,∗∗ (, )@PKU1898@YaleMed@JElefteriades
- aAortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut
- bDepartment of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College, Beijing, China
- cDepartment of Political Sciences and Economics, Rowan University, Glassboro, New Jersey
- dSchool of Acu-moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China
- eDepartment of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia
- fDepartment of Economics and Department of Preventive Medicine, Stony Brook University, Stony Brook, New York
Background Little information is available regarding the longitudinal changes of the aneurysmal ascending aorta.
Objectives This study sought to outline the natural history of ascending thoracic aortic aneurysm (ATAA) based on ascending aortic length (AAL) and develop novel predictive tools to better aid risk stratification.
Methods The ascending aortic diameters and lengths, and long-term aortic adverse events (AAEs) (rupture, dissection, and death) of 522 ATAA patients were evaluated using comprehensive statistical approaches.
Results An AAL of ≥13 cm was associated with an almost 5-fold higher average yearly rate of AAEs compared with an AAL of <9 cm. Two AAL “hinge points” with a sharp increase in the estimated probability of AAEs were detected between 11.5 and 12.0 cm, and between 12.5 and 13.0 cm. The mean estimated annual aortic elongation rate was 0.18 cm/year, and aortic elongation was age dependent. Aortic diameter increased 18% due to dissection while AAL only increased by 2.7%. There was a noticeable improvement in the discrimination of the logistic regression model (area under the receiver-operating characteristic curve: 0.810) due to the introduction of aortic height index (AHI) (diameter height index + length height index). The AHIs <9.33, 9.38 to 10.81, 10.86 to 12.50, and ≥12.57 cm/m were associated with a ∼4%, ∼7%, ∼12%, and ∼18% average yearly risk of AAEs, respectively.
Conclusions An aortic elongation of 11 cm serves as a potential intervention criterion for ATAA, which is even more reliable than diameter due to its relative immunity to dissection. AHI (including both length and diameter) is more powerful than any single parameter in this study.
- aortic adverse events
- aortic aneurysm
- aortic dimensions
- aortic elongation
- natural history
- thoracic aortic aneurysm
↵∗ Drs. Wu and Zafar contributed equally to this work.
Dr. Yu has received a grant from the CAMS Initiative for Innovative Medicine; and has served as a consultant for Beijing HuaMaiTaiKe Medical Apparatus and Appliances Co. Dr. Elefteriades has served as a consultant for CryoLife; has served on the Data Safety and Monitoring Board for Jarvik Heart and Terumo; and is co-founder of CoolSpine. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received June 1, 2019.
- Revision received July 24, 2019.
- Accepted July 28, 2019.
- 2019 American College of Cardiology Foundation
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