Prognostic role of the ascending aorta dilatation in patients with arterial hypertension

Abstract

Background: Ascending aorta (ASC) dilatation (AAD) is a common finding in arterial hypertension, affecting about 15% of hypertensive patients. AAD is associated with an increase in cardiac and vascular hypertension-related organ damage, but its prognostic role is unknown. The aim of the study was to evaluate the prognostic value of AAD as predictor of cardiovascular events in essential hypertensive patients.Methods: Recruited patients underwent two-dimensional transthoracic echocardiography from 2007 to 2013 and followed-up for cardiovascular events until November 2018 by phone call and hospital information system check. ASC diameter and AAD were defined using both absolute and scaled definitions. Four hundred and twenty-three hypertensive patients were included in our study.Results: During a median follow-up of 7.4 years (interquartile range 5.6-9.1 years), 52 events were observed. After adjusting for age, sex and BSA, both ASC diameter and AAD definition, according to ARGO-SIIA project, resulted associated with a greater risk of cardiovascular event (both P < 0.010), even after adjusting for major confounders (both P < 0.010). Moreover, we observed that the assessment of ASC improves risk stratification compared with pulse wave velocity alone, and that in absence of AAD, sinus of valsalva dilatation lost any prognostic value (P ¼ 0.262).Conclusions: ASC diameter and AAD are both associated with a greater risk of cardiovascular events. ASC should be assessed to optimize risk stratification in hypertensive patients and its dilatation may be considered as a surrogate for vascular organ damage.

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

“…Therefore, 190 studies were reviewed; of these, 101 did not report data on incident non-fatal or fatal cardiovascular events or all-cause mortality and 41 on AR diameter or ascending aorta data, 33 were review, commentary, editorial articles, and 6 were excluded for miscellaneous reasons. A total of 9 studies, including participants without underlying known aortic pathologies (i.e., aneurysms) or connective diseases and containing sufficient clinical and cardiac imaging data, were included in the final review (17)(18)(19)(20)(21)(22)(23)(24)(25) (Figure 1). The Newcastle-Ottawa Score, used for assessing the quality of the studies, ranged from 7 to 9, and the mean score was 7.8.…”

“…This was not the case, however, in the PAMELA study in which the association of AR diameter with incident cardiovascular events lost its significance when LV mass index was included in the multivariate analysis (21). Studies targeting ascending aortic diameter (19,23,25) showed non-univocal findings. Among the participants from the Framingham offspring and third-generation cohorts, the enlarged ascending aorta was not significantly associated with cardiovascular events (23).…”

“…The mean age range was 49-73 years (17,23); 51% of participants were men. The majority of studies included freeliving members of the general population, two studies were carried out in hypertensive cohorts (24,25) and one study in patients undergoing chest computed tomography (CT) for non-cardiovascular indications (19). The duration of the follow-up period ranged from 17 months (19) to 12 years (18,21).…”

“…AR diameter was measured in the parasternal long-axis view at the level of Valsalva's sinuses in six echocardiographic studies (17,18,(20)(21)(22)24). The diameter of ascending aorta was the vascular phenotype of interest in both CT studies (19,23) and in one of the echocardiographic studies (25).…”

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

“…The findings in favour of the independent value of aortic root in predicting cardiovascular outcomes is based on few prospective studies performed in northern American and European population-based samples as well as in hypertensive cohorts [11][12][13][14][15]. The Cardiovascular Health Study, including 3993 elderly without overt cardiovascular disease at baseline from a bi-racial sample of the general population, was the first to open this line of research [11].…”