Hena N Patel1, Tatsuya Miyoshi2, Karima Addetia1, Rodolfo Citro3, Masao Daimon4, Pedro Gutierrez Fajardo5, Ravi R Kasliwal6, James N Kirkpatrick7, Mark J Monaghan8, Denisa Muraru9, Kofo O Ogunyankin10, Seung Woo Park11, Ricardo E Ronderos12, Anita Sadeghpour13, Gregory M Scalia14, Masaaki Takeuchi15, Wendy Tsang16, Edwin S Tucay17, Ana Clara Tude Rodrigues18, Vivekanandan Amuthan19, Yun Zhang20, Marcus Schreckenberg21, Michael Blankenhagen21, Markus Degel21, Niklas Hitschrich21, Victor Mor-Avi1, Federico M Asch2, Roberto M Lang22. 1. University of Chicago, Chicago, Illinois. 2. MedStar Health Research Institute, Washington, District of Columbia. 3. University of Salerno, Salerno, Italy. 4. University of Tokyo, Tokyo, Japan. 5. Hospital Bernardette, Guadalajara, Mexico. 6. Medanta Medicity, Gurgoan, India. 7. University of Washington, Seattle, Washington. 8. King's College Hospital, London, United Kingdom. 9. University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Milan, Italy. 10. First Cardiology Consultants Hospital Ikoyi, Lagos, Nigeria. 11. Samsung Medical Center/Sungkyunkwan University School of Medicine, Seoul, Korea. 12. Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina. 13. Rajaie Cardiovascular Medical Center, Iran University of Medical Sciences, Tehran, Iran. 14. GenesisCare, Brisbane, Australia. 15. University of Occupational and Environmental Health, Kitakyushu, Japan. 16. Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada. 17. Philippine Heart Center, Quezon City, Philippines. 18. Hospital Israelita Albert Einstein, São Paulo, Brazil. 19. Jeyalakshmi Heart Center, Madurai, India. 20. Qilu Hospital of Shandong University, Jinan, China. 21. TomTec Imaging Systems, Unterschleissheim, Germany. 22. University of Chicago, Chicago, Illinois. Electronic address: rlang@medicine.bsd.uchicago.edu.
Abstract
BACKGROUND: Accurate measurements of the aortic annulus and root are important for guiding therapeutic decisions regarding the need for aortic surgery. Current echocardiographic guidelines for identification of aortic root dilatation are limited because current normative values were derived predominantly from white individuals in narrow age ranges, and based partially on M-mode measurements. Using data from the World Alliance Societies of Echocardiography study, the authors sought to establish normal ranges of aortic dimensions across sexes, races, and a wide range of ages. METHODS: Adult individuals free of heart, lung, and kidney disease were prospectively enrolled from 15 countries, with even distributions among sexes and age groups: young (18-40 years), middle aged (41-65 years) and old (>65 years). Transthoracic two-dimensional echocardiograms of 1,585 subjects (mean age, 47 ± 17 years; 50.4% men; mean body surface area [BSA], 1.77 ± 0.22 m2) were analyzed in a core laboratory following American Society of Echocardiography guidelines. Measurements, indexed separately by BSA and by height, included the aortic annulus, sinuses of Valsalva, and sinotubular junction. Differences among age, sex, and racial groups were evaluated using unpaired two-tailed Student's t tests. RESULTS: All aortic root dimensions were larger in men compared with women. After indexing to BSA, all measured dimensions were significantly larger in women, whereas men continued to show larger dimensions after indexing to height. Of note, the upper limits of normal for all aortic dimensions were lower across all age groups, compared with the guidelines. Aortic dimensions were larger in older age groups in both sexes, a trend that persisted regardless of BSA or height adjustment. Last, differences in aortic dimensions were also observed according to race: Asians had the smallest nonindexed aortic dimensions at all levels. CONCLUSIONS: There are significant differences in aortic dimensions according to sex, age, and race. Thus, current guideline-recommended normal ranges may need to be adjusted to account for these differences.
BACKGROUND: Accurate measurements of the aortic annulus and root are important for guiding therapeutic decisions regarding the need for aortic surgery. Current echocardiographic guidelines for identification of aortic root dilatation are limited because current normative values were derived predominantly from white individuals in narrow age ranges, and based partially on M-mode measurements. Using data from the World Alliance Societies of Echocardiography study, the authors sought to establish normal ranges of aortic dimensions across sexes, races, and a wide range of ages. METHODS: Adult individuals free of heart, lung, and kidney disease were prospectively enrolled from 15 countries, with even distributions among sexes and age groups: young (18-40 years), middle aged (41-65 years) and old (>65 years). Transthoracic two-dimensional echocardiograms of 1,585 subjects (mean age, 47 ± 17 years; 50.4% men; mean body surface area [BSA], 1.77 ± 0.22 m2) were analyzed in a core laboratory following American Society of Echocardiography guidelines. Measurements, indexed separately by BSA and by height, included the aortic annulus, sinuses of Valsalva, and sinotubular junction. Differences among age, sex, and racial groups were evaluated using unpaired two-tailed Student's t tests. RESULTS: All aortic root dimensions were larger in men compared with women. After indexing to BSA, all measured dimensions were significantly larger in women, whereas men continued to show larger dimensions after indexing to height. Of note, the upper limits of normal for all aortic dimensions were lower across all age groups, compared with the guidelines. Aortic dimensions were larger in older age groups in both sexes, a trend that persisted regardless of BSA or height adjustment. Last, differences in aortic dimensions were also observed according to race: Asians had the smallest nonindexed aortic dimensions at all levels. CONCLUSIONS: There are significant differences in aortic dimensions according to sex, age, and race. Thus, current guideline-recommended normal ranges may need to be adjusted to account for these differences.
Authors: Ryan R Davies; Amy Gallo; Michael A Coady; George Tellides; Donald M Botta; Brendan Burke; Marcus P Coe; Gary S Kopf; John A Elefteriades Journal: Ann Thorac Surg Date: 2006-01 Impact factor: 4.330
Authors: Carol Mitchell; Peter S Rahko; Lori A Blauwet; Barry Canaday; Joshua A Finstuen; Michael C Foster; Kenneth Horton; Kofo O Ogunyankin; Richard A Palma; Eric J Velazquez Journal: J Am Soc Echocardiogr Date: 2018-10-01 Impact factor: 5.251
Authors: David Oxborough; Saqib Ghani; Allan Harkness; Guy Lloyd; William Moody; Liam Ring; Julie Sandoval; Roxy Senior; Nabeel Sheikh; Martin Stout; Victor Utomi; James Willis; Abbas Zaidi; Richard Steeds Journal: Echo Res Pract Date: 2014-05-06