Jinlin Wu1, Mohammad A Zafar2, Yupeng Li3, Ayman Saeyeldin4, Yan Huang5, Rui Zhao6, Juntao Qiu6, Maryam Tanweer4, Mohamed Abdelbaky4, Anton Gryaznov4, Joelle Buntin4, Bulat A Ziganshin7, Sandip K Mukherjee4, John A Rizzo8, Cuntao Yu9, John A Elefteriades10. 1. Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College, Beijing, China. Electronic address: https://twitter.com/jinlinhorsy. 2. Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut. Electronic address: https://twitter.com/MohammadAZafar. 3. Department of Political Sciences and Economics, Rowan University, Glassboro, New Jersey. 4. Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut. 5. School of Acu-moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, China. 6. Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College, Beijing, China. 7. Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut; Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University, Kazan, Russia. 8. Department of Economics and Department of Preventive Medicine, Stony Brook University, Stony Brook, New York. 9. Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Peking Union Medical College, Beijing, China. Electronic address: cuntaoyu_fuwai@163.com. 10. Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut. Electronic address: john.elefteriades@yale.edu.
Abstract
BACKGROUND: Little information is available regarding the longitudinal changes of the aneurysmal ascending aorta. OBJECTIVES: This study sought to outline the natural history of ascending thoracic aortic aneurysm (ATAA) based on ascending aortic length (AAL) and develop novel predictive tools to better aid risk stratification. METHODS: The ascending aortic diameters and lengths, and long-term aortic adverse events (AAEs) (rupture, dissection, and death) of 522 ATAA patients were evaluated using comprehensive statistical approaches. RESULTS: An AAL of ≥13 cm was associated with an almost 5-fold higher average yearly rate of AAEs compared with an AAL of <9 cm. Two AAL "hinge points" with a sharp increase in the estimated probability of AAEs were detected between 11.5 and 12.0 cm, and between 12.5 and 13.0 cm. The mean estimated annual aortic elongation rate was 0.18 cm/year, and aortic elongation was age dependent. Aortic diameter increased 18% due to dissection while AAL only increased by 2.7%. There was a noticeable improvement in the discrimination of the logistic regression model (area under the receiver-operating characteristic curve: 0.810) due to the introduction of aortic height index (AHI) (diameter height index + length height index). The AHIs <9.33, 9.38 to 10.81, 10.86 to 12.50, and ≥12.57 cm/m were associated with a ∼4%, ∼7%, ∼12%, and ∼18% average yearly risk of AAEs, respectively. CONCLUSIONS: An aortic elongation of 11 cm serves as a potential intervention criterion for ATAA, which is even more reliable than diameter due to its relative immunity to dissection. AHI (including both length and diameter) is more powerful than any single parameter in this study.
BACKGROUND: Little information is available regarding the longitudinal changes of the aneurysmal ascending aorta. OBJECTIVES: This study sought to outline the natural history of ascending thoracic aortic aneurysm (ATAA) based on ascending aortic length (AAL) and develop novel predictive tools to better aid risk stratification. METHODS: The ascending aortic diameters and lengths, and long-term aortic adverse events (AAEs) (rupture, dissection, and death) of 522 ATAA patients were evaluated using comprehensive statistical approaches. RESULTS: An AAL of ≥13 cm was associated with an almost 5-fold higher average yearly rate of AAEs compared with an AAL of <9 cm. Two AAL "hinge points" with a sharp increase in the estimated probability of AAEs were detected between 11.5 and 12.0 cm, and between 12.5 and 13.0 cm. The mean estimated annual aortic elongation rate was 0.18 cm/year, and aortic elongation was age dependent. Aortic diameter increased 18% due to dissection while AAL only increased by 2.7%. There was a noticeable improvement in the discrimination of the logistic regression model (area under the receiver-operating characteristic curve: 0.810) due to the introduction of aortic height index (AHI) (diameter height index + length height index). The AHIs <9.33, 9.38 to 10.81, 10.86 to 12.50, and ≥12.57 cm/m were associated with a ∼4%, ∼7%, ∼12%, and ∼18% average yearly risk of AAEs, respectively. CONCLUSIONS: An aortic elongation of 11 cm serves as a potential intervention criterion for ATAA, which is even more reliable than diameter due to its relative immunity to dissection. AHI (including both length and diameter) is more powerful than any single parameter in this study.
Authors: Athanassios Pirentis; Paris D Kalogerakos; Hamid Mojibian; John A Elefteriades; George Lazopoulos; Yannis Papaharilaou Journal: Med Biol Eng Comput Date: 2022-05-17 Impact factor: 2.602
Authors: Matthew D Solomon; Thomas Leong; Sue Hee Sung; Catherine Lee; J Geoff Allen; Joseph Huh; Paul LaPunzina; Hon Lee; Duncan Mason; Vicken Melikian; Daniel Pellegrini; David Scoville; Ahmad Y Sheikh; Dorinna Mendoza; Sahar Naderi; Ann Sheridan; Xinge Hu; Wendy Cirimele; Anne Gisslow; Sandy Leung; Kristine Padilla; Michael Bloom; Josh Chung; Adrienne Topic; Paniz Vafaei; Robert Chang; D Craig Miller; David H Liang; Alan S Go Journal: JAMA Cardiol Date: 2022-10-05 Impact factor: 30.154
Authors: Yunus Ahmed; Nitesh Nama; Ignas B Houben; Joost A van Herwaarden; Frans L Moll; David M Williams; C Alberto Figueroa; Himanshu J Patel; Nicholas S Burris Journal: Eur J Cardiothorac Surg Date: 2021-09-11 Impact factor: 4.191
Authors: M J P van Hout; J F Juffermans; H J Lamb; E S J Kröner; P J van den Boogaard; M J Schalij; I A Dekkers; A J Scholte; J J Westenberg Journal: Int J Cardiol Heart Vasc Date: 2021-12-13