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Ascending Aortic Dimensions in Hypertensive Subjects: Reference Values for Two-Dimensional Echocardiography
Enrico Vizzardi1, Francesco Maffessanti2, Roberto Lorusso3
1Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Community Hospital and University of Brescia, Brescia, Italy.
Insights
Hypertension is linked to larger aortic diameters, particularly at the sinotubular junction and aortic arch. This study confirms hypertension as an independent factor for aortic dilation, impacting cardiovascular disease risk.
Area of Science:
- Cardiology
- Vascular Biology
- Medical Imaging
Background:
- Aortic dilation is a key indicator of cardiovascular disease risk.
- The relationship between hypertension and aortic dilation remains debated, with limited data on the ascending aorta.
- Previous studies primarily focused on the aortic root, neglecting other segments.
Purpose of the Study:
- To investigate ascending aorta (AscAo) dimensions in hypertensive individuals.
- To determine if hypertension is an independent risk factor for aortic dilation across multiple aortic segments.
- To assess the prevalence of aortic dilation in hypertensive patients.
Main Methods:
- Prospective enrollment of 1,027 hypertensive patients and 1,002 healthy controls.
- Two-dimensional echocardiography used to measure aortic diameters at four levels: sinuses of Valsalva, sinotubular junction (STJ), AscAo, and aortic arch (AoArch).
- Measurements were taken at end-diastole using the leading edge-to-leading edge convention.
Main Results:
- Hypertensive patients exhibited significantly larger aortic diameters compared to controls.
- Age, body size, and male sex were correlated with increased aortic diameters.
- Multivariate analysis confirmed hypertension as an independent factor associated with increased diameters at all measured levels, with notable increases at the STJ (4.1 mm) and AoArch (2.2 mm).
- A high prevalence of aortic dilation was observed in hypertensive patients at the STJ (14%) and AoArch (7%).
Conclusions:
- Hypertension is an independent predictor of aortic dilation, alongside age, sex, and body surface area.
- The study highlights increased aortic diameters in hypertensive patients across all measured segments.
- Aortic dilation is more prevalent at the sinotubular junction and aortic arch in hypertensive individuals, underscoring the need for cardiovascular risk assessment.
Background:
Aortic dilation is an independent predictor of cardiovascular disease. The association between hypertension and aortic dilation is still controversial. Also, most previous research has investigated this relationship regarding only the aortic root, and no information is available for the ascending aorta (AscAo).
Methods:
To assess AscAo dimensions in hypertensive patients, 1,027 patients with hypertension and 1,002 healthy volunteers were prospectively enrolled. Aortic diameters at four levels were measured using the leading edge-to-leading edge convention at end-diastole: the sinuses of Valsalva, sinotubular junction (STJ), AscAo, and aortic arch (AoArch), using two-dimensional echocardiography.
Results:
All four diameters were significantly larger in hypertensive patients than in control subjects, with positive correlations with age, body size, and male sex. On multivariate analysis, gender and body surface area were independently associated with aortic diameters. The general linear model showed that after adjusting for age, sex, and body surface area, hypertension was positively associated (P < .01) with higher aortic diameter at every level. Hypertension was associated with increases of 1.7 mm (95% CI, 1.2-2.1 mm) at the sinuses of Valsalva, 4.1 mm (95% CI, 3.6-4.6 mm) at the STJ, 1.6 mm (95% CI, 1.1-2.1 mm) at the AscAo, and 2.2 mm (95% CI, 1.7-2.6 mm) at the AoArch. On the basis of nomograms, an abnormally high prevalence of aortic dilation in hypertensive patients was observed for the STJ (14%) and the AoArch (7%).
Conclusions:
Systematic analysis of the AscAo in hypertensive patients showed that, together with age, sex, and body surface area, hypertension is an independent factor associated with increases in all four aortic diameters and that aortic dilation occurred more frequently at the level of the STJ and AoArch.
