Aortic dimensions in tall men and women

doi:10.1016/0002-9149(93)90523-F

The American Journal of Cardiology

Volume 71, Issue 7, 1 March 1993, Pages 608-610

https://doi.org/10.1016/0002-9149(93)90523-F Get rights and content

Abstract

Subjects with the Marfan syndrome are at risk for sudden death from aortic regurgitation, dissection or rupture. The severity of aortic regurgitation correlates with the degree of aortic root dilation, not annular dilation.^1,2 The risk of aortic dissection increases with aortic enlargement.^1,2 Aortic dissection may occur with only moderate aortic root dilation.¹ Because Marfan patients with nonenlarged aortic roots are thought to be at low risk for aortic dissection and rupture,¹ it is critical to define an enlarged aortic root. Nomograms that have been published for normal aortic root dimensions have not included a sufficient number of healthy subjects whose height exceeds the 95th percentile,^3–7 usually present in Marfan patients. Thus, we do not know the normal aortic root dimensions for subjects whose body size is equivalent to those with the Marfan syndrome. This study examines the acceptable upper limit of normal for the aortic root in healthy subjects taller than the 95th percentile. The data were sought for use in determining which Marfan patients have aortic roots of greater than normal size, thus warranting pharmacologic intervention and activity restriction.

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Competitive athletes were compared with sedentary subjects and patients with aortic dilatation. 1901 subjects who underwent echocardiography from 2019 to 2022 were retrospectively enrolled: 993 athletes (74% males, mean age 26 ± 7 years), 410 sedentary (74.1% males, mean age 29 ± 11 years) and 498 patients with aortic dilatation (74.3% males, mean age 56 ± 7 years).
Patients with aortic dilatation had both an absolute (39.2 ± 2.4 mm) and indexed (19.4 ± 2.2 mm/m2) aortic diameter larger than athletes (30.6 ± 3.2 mm; 16.1 ± 1.5 mm/m², p < 0.05) and sedentary subjects (30.5 ± 3.1 mm; 16.5 ± 1.6 mm/m², p < 0.05), with no differences between athletes and sedentary subjects. The AoD/LVEDD ratio was lower in athletes (0.59 ± 0.06) compared to controls (0.65 ± 0.05, p < 0.05) and patients with aortic dilatation (0.81 ± 0.06, p < 0.05). The patients with aortopathy had the lowest LVEDD/AoD ratio, while competitive athletes had the highest, with values of 1.71 ± 0.16 in the latter (overall p value<0.001).
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2023, Athlete's Heart: A Multimodal Approach - From Physiological to Pathological Cardiac Adaptations
Due to its ability to provide information on cardiac morphology, function, and hemodynamics, the use of echocardiography in athlete’s evaluation is increasing. Cardiovascular adaptations of athlete’s heart include balanced increases in all chambers: dilation, increase of wall thickness, hypertrabeculation and normal systolic and diastolic function of the left ventricle; dilation of left and right atrium; increase of diameters, increase of outflow tract and normal systolic function of right ventricle. Moreover, an increase of aortic root and ascending aorta is commonly observed in athletes. In the past decades, advances in ultrasound technology have resulted in the evolution of echocardiography from the simple M-mode to two-dimensional imaging, Doppler assessments, three-dimensional anatomical imaging, and dimensional analysis of myocardial deformation. The scientific literature offers echocardiographic cutoff measures to distinguish between physiologic and pathologic cardiac adaptations.
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Surveillance metrics in pediatric and young adult Marfan syndrome (pMFS) are challenging. We evaluated the utility of aortic root cross-sectional area/height index (CSA/Ht) on echocardiogram among pMFS patients as a risk stratification and surgical triage metric.
Genotype or phenotype positive pMFS patients aged 25 years or younger seen at our center from 2001 to 2020 were identified. Time-related transition to surgery was modeled using parametric methods. Predictive utility of CSA/Ht compared with aortic root diameter (ARd) and root Z score (ARz) were modeled using nonlinear multivariable parametric and nonparametric longitudinal regression models.
Seventy-nine patients (43% female) presented at median age of 5.8 years (15th-85th percentile, 0.75-17 years) with median follow-up of 4.4 years (range, 0-18.5 years). Baseline echocardiography data were: CSA/Ht, 3.9 ± 1.4 cm²/m; ARd, 2.4 ± 0.89 cm; and ARz, 2.4 ± 1.7. CSA/Ht tracked ARd better compared with ARz (r = 0.91 vs 0.24). Eighteen patients underwent surgery. Surgical procedures included at least 2 components in 17 (aortic, mitral, tricuspid, aortic root, and arch procedures) and isolated mitral valve procedures in 1 patient. Time-related transition to surgery showed a prominent early phase to 1 year post presentation, followed by a slowly increasing late phase. CSA/Ht had a more linear correlation versus ARz during periods of rapid somatic growth in surgical patients. Surgical repair occurred at CSA/Ht between 5 and 7 cm²/m.
CSA/Ht tracked ARd well over time. CSA/Ht between 5 and 7 cm²/m might be a promising metric for surgical triage in pMFS patients. CSA/Ht surgical threshold values in pMFS patients occurred at lower than current accepted “surgical” threshold values for CSA/Ht in adult Marfan syndrome patients.
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A multidisciplinary panel of experts including cardiologists, cardiothoracic surgeons, clinical geneticists and general practitioners, convened to review and discuss the current literature, guidelines and clinical practice on genetic testing and family screening in TAA.
There is a lack of high-quality evidence in the literature. This consensus statement, based on the available literature and expert opinions, summarizes our recommendations in order to standardize and optimize the cardiogenetic care for patients and families with thoracic aortic disease. In particular, we provide criteria to identify those patients most likely to have a genetic predisposition, and discuss the preferred modality and frequency of screening in their relatives.
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Sixty-one patients (31 men, mean age 50.8 [18–82]) with a normal anatomy were included in the study. Measurements included the diameters of the AA and SAT in 17 locations, their distance and angulation based on computed tomography angiography data. Statistical analysis focused on descriptive statistics, differences between genders, as well as correlations with age.
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^☆: This study was supported by Grant GCRC RR-00211 from the University of Tennessee Clinical Research Center, Memphis, Tennessee.

¹: Dr. Alpert's current address is: Physicians Office Building, Suite 215, 777 Washington Avenue, Memphis, Tennessee 38105.

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Brief reportAortic dimensions in tall men and women☆

Abstract

Am J Cardiol

Am J Cardiol

Aortic complications in adult Marfan Syndrome are associated with the aortic root diameter (abstr)

Clin Res

Aortic root dilatation as a cause of isolated severe aortic regurgitation. Prevalence, clinical and echocardiographic patterns, and relation to left ventricular hypertrophy and function

Ann Intern Med

Brief report
Aortic dimensions in tall men and women☆