Incident aortic root dilatation in the general population: findings from the Pamela study

Abstract

We sought to assess the long-term changes in aortic root diameter in a population-based sample, focusing on new-onset aortic root dilatation, as well as on the demographic and clinical variables independently related to this dynamic process.Methods: A total of 1122 participants with measurable echocardiographic parameters at baseline and after a 10-year follow-up were included in the analysis. Sexspecific upper limits of normality for absolute aortic root diameter, aortic root diameter indexed to body surface area (BSA) and to height were derived from 712 healthy normotensive PAMELA participants.Results: Over the 10-year follow-up, new aortic root dilatation occurred in 3.4% (aortic root /BSA), 4.4% (aortic root /height) and 7.3% (absolute aortic root), respectively. No substantial relationship was observed between baseline office and ambulatory blood pressure (BP) or their changes over time and incident aortic root /BSA and aortic root /height dilatation. Baseline aortic root diameter and left ventricular mass index (LVMI) emerged as important predictors of aortic root dilation, regardless of the diagnostic criteria used. This was also the case for the 10-year change in LVMI. The strength of association between nonhemodynamic variables and new-onset aortic root dilatation was variable, depending on the definition of the aortic phenotype. Conclusion:The incidence of aortic root dilatation in a general middle-aged population is a relatively infrequent but not so rare event and scarcely influenced by both office and out-office BP. On the contrary, it is strongly related to LVMI (and its variations over time). From a clinical perspective, this underlines that LVH prevention and regression can reduce the risk of aortic root dilatation in the community.

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

“…It should be noted, however, that available evidence regarding dynamic changes over time in AR diameter in the community and in hypertensive cohorts suggests somewhat different conclusions from cross-sectional studies. Indeed, among the participants to the PAMELA study, the incidence of new AR dilatation over the 10-year follow-up period ranged from 3.4% (AR/BSA) to 4.4% (AR/height) (33). In difference, the Campania Salute Network study, including 4,856 hypertensive patients, showed that as many as 366 participants (11%) with normal AR diameter at baseline developed AR dilatation during a follow-up of 6 years (34).…”

Prevalence of cardiovascular manifestations in patients with hypermobile Ehlers‐Danlos syndrome at the University of Miami

“…The ARD prevalence in 1860 randomly selected healthy subjects from the general population of Monza (Milan, Italy), aged 25 to 74 years, ranged from 5.6% to 9.6%, indexed to the body surface area and height, respectively. Sex‐specific prevalence was slightly higher in men than women (Cuspidi, 2022).…”

“…We reviewed the echocardiogram and electrocardiogram (ECG) findings in hEDS patients seen at the University of Miami. We compared our results with other studies on cardiac presentations of hEDS and published epidemiologic studies (Asher et al, 2018;Atzinger et al, 2011;Cuspidi et al, 2022) of MVP and ARD, on similar gender and age subjects in the general population. We aim to provide further evidence toward more defined and reliable diagnostic criteria and recommended monitoring.…”

Proximal aorta dilatation in hypertension

“…Parallel changes between proximal aortic dilatation and hypertensive target organ damage left ventricular hypertrophy and atrial fibrillation LVH is traditional hypertensive target organ damage and is associated with adverse cardiovascular outcomes. Crosssectional studies have witnessed a higher prevalence of LVH in hypertensive patients with proximal aortic dilation than their counterparts with normal proximal aorta (OR ¼ 2.4 for ascending aorta dilation [89], OR ¼ 3.1 for the aortic root dilation [10]). Moreover, the prevalence of LVH showed a stepwise increase with the aortic size tertile rising in a never treated hypertensive population [9].…”

“…Additionally, proximal aortic dilatation has been regarded as a morphological manifestation of vascular remodeling and is closely associated with traditional cardiovascular risk factors like left ventricular hypertrophy (LVH) and arteriosclerosis [1,[9][10][11][12]. However, the long-term prognostic value of proximal aortic dilatation has not been confirmed in hypertensive patients, which maybe one of the reasons why this indicator was not included as a risk stratification factor in current guidelines for hypertension [13,14].…”