Aortic Root Remodeling as an Indicator for Diastolic Dysfunction and Normative Ranges in Asians: Comparison and Validation with Multidetector Computed Tomography

Abstract

Background: The aortic root diameter (AoD) has been shown to be a marker of cardiovascular risk and heart failure (HF). Data regarding the normal reference ranges in Asians and their correlates with diastolic dysfunction using contemporary guidelines remain largely unexplored. Methods: Among 5343 consecutive population-based asymptomatic Asians with echocardiography evaluations for aortic root diameter (without/with indexing, presented as AoD/AoDi) were related to cardiac structure/function and N-terminal pro-brain B-type natriuretic peptide (Nt-ProBNP), with 245 participants compared with multidetector computed tomography (MDCT)-based aortic root geometry. Results: Advanced age, hypertension, higher diastolic blood pressure, and lower body fat all contributed to greater AoD/AoDi. The highest correlation between echo-based aortic diameter and the MDCT-derived measures was found at the level of the aortic sinuses of Valsalva (r = 0.80, p < 0.001). Age- and sex-stratified normative ranges of AoD/AoDi were provided in 3646 healthy participants. Multivariate linear regressions showed that AoDi was associated with a higher NT-proBNP, more unfavorable left ventricular (LV) remodeling, worsened LV systolic annular velocity (TDI-s′), a higher probability of presenting with LV hypertrophy, and abnormal LV diastolic indices except tricuspid regurgitation velocity by contemporary diastolic dysfunction (DD) criteria (all p < 0.05). AoDi superimposed on key clinical variables significantly expanded C-statistic from 0.71 to 0.84 (p for ∆AUROC: < 0.001). These associations were broadly weaker for AoD. Conclusion: In our large asymptomatic Asian population, echocardiography-defined aortic root dilation was associated with aging and hypertension and were correlated modestly with computed tomography measures. A larger indexed aortic diameter appeared to be a useful indicator in identifying baseline abnormal diastolic dysfunction.

Is Thoracic Aortic Diameter an Independent Predictor of Cardiovascular Disease and Mortality? A Narrative Review

“…These observations suggest that alterations of the aortic wall structure/function associated with dilatation may contribute to increased LV afterload, an important factor leading to LVH. Thus, the dilatation of the most proximal arterial segment (i.e., AR and ascending tract), in addition to being a known risk factor for aortic dissection, can be considered a sign of TOD paralleling other cardiac markers of established prognostic value (39,40). In particular, the association between aortic dilatation and LVH emphasizes the role of combined arterial-ventricular remodeling in the progression of cardiovascular continuum.…”

It’s Time to Add Electrocardiography and Echocardiography to CVD Risk Prediction Models: Results from a Prospective Cohort Study

“… 52 Utsunomiya et al 53 revealed that echocardiographic total heart calcification (THC) score, which was composed of aortic valve calcification, mitral annular calcification, and aortic root calcification, had an enhancing and independent role in forecasting the mortality and morbidity of CVD. Liu et al 54 showed that aortic root diameter (AoD) could be a useful marker to identify cardiovascular risk and heart failure (HF). The authors found that advanced age, and worse hypertension and diastolic blood pressure were associated with greater AoD.…”

Period of Arrhythmia Anchored around an Infarction Scar in an Anatomical Model of the Human Ventricles

“…Note that mathematical methods are widely used in various applications in cardiology, such as in the basic study of arrhythmia sources [29], correlation of cardiovascular risk markers [30], to support and optimize the relevant choices in cardiac surgery via building us mathematical models [31], and to develop novel ways of assessment of properties of the heart via ultrafast shear wave imaging based on multiphysics platform which includes modeling parts [32].…”