Correspondence on "aortic enlargement and COVID-19".

Dear Editor, we would like to share ideas on the publication “An interesting finding: What is the relation between aortic enlargement and COVID-19?[1]” In the present study, medical records and thorax tomographies of patients were analyzed. Bitargil et al. mentioned that “the mean aortic diameter of COVID-19 patients is larger than non–COVID-19 patients with similar comorbidities referred to a pandemic …… COVID-19 was the leading factor.[1]” We agree that COVID-19 might have some clinical effects on vascular system. If COVID-19 results in enlargement of aorta, the pathological process should be acute process that the change can be detected in a short period of infection. The possible pathological process might be an inflammatory process affect heart and large vessel.[2]

The present study might show that there is a significant increased diameter of aorta in COVID-19 case. The diameter enlargement might or might not be associated with COVID-19. The important concern is on the pre-COVID-19 vascular status of the patients. In this study, there is no data on pre–COVID-19 vascular/health status of the patients. As Bitargil et al. noted, there are several possible confounding factors that might affect the aorta. Some patients might already have the vascular problem prior to COVID-19. In addition to the underlying personal illness, there is possibility of other concurrent medical problem in COVID-19 patient that might also cause enlargement of aorta. For example, dengue is a possible concurrent medical problem[3] and dengue can cause enlargement of aorta.[4]

Regarding the investigation technique, thorax tomography, the diameter of the aorta grows with age and male gender.[5] To distinguish pathologic atherosclerotic alterations in the ascending aorta, gender-specific and age-adjusted aortic diameter are required.[5] Finally, it should be noted that the interpersonal variability in interpretation of aorta diameter from tomography image is high[5] and if there are many tomography radiologists in the present report by Bitargil et al., it is necessary to assess interpersonal variability. These points should be discussed and if further studies are conducted, it is necessary to recognize these basic considerations.