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Canadian Journal of Cardiology

Combining aortic size with arterial hemodynamics enhances assessment of future thoracic aortic aneurysm expansion

Published:September 19, 2022DOI:https://doi.org/10.1016/j.cjca.2022.09.010

      Abstract

      Background

      Thoracic aortic aneurysm (TAA) is a deadly disease whose current method for risk stratification (aneurysm size) is imperfect. We sought to evaluate whether combining aortic size with hemodynamic measures that reflect the aorta’s function was superior to aortic size alone in the assessment of thoracic aortic aneurysm (TAA) expansion.

      Methods

      One hundred and thirty-seven unoperated participants with TAA were followed prospectively. Aortic stiffness and pulsatile hemodynamics were non-invasively assessed at baseline combining arterial tonometry with echocardiography, using validated methodology. Aneurysm growth was calculated from standard imaging modalities. Multivariable linear regression models adjusted for potential confounders evaluated the association of aneurysm size and arterial hemodynamics, alone and in combination, with TAA growth.

      Results

      Sixty nine percent of participants were men. Mean ± SD age, baseline aneurysm size, follow-up and aneurysm expansion were 62.2±11.4 years, 45.9±4.0 cm, 4.5±1.9 years and 0.41±0.46mm/year, respectively. In the linear regression models, the standardized β (β*) for the association of aneurysm size with aneurysm expansion was 0.178 (P=0.044). This was improved by combining aortic size with most measures of aortic function, with β* ranging from 0.192 (for aneurysm size combined with central diastolic blood pressure) to 0.484 (for aneurysm size combined with carotid-femoral pulse wave velocity) (P≤0.05 for each).

      Conclusions

      Combining aneurysm size with measures of arterial function improves assessment of aneurysm growth over TAA size alone, which is the standard for clinical decisions in TAA. Thus, combining aneurysm size with measures of aortic function provides a clinical advantage in the assessment of TAA disease activity.

      Keywords

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