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Published on: March 8, 2019
Increased Aortic Diameters on Multidetector Computed Tomographic Scan Are Independent Predictors of Incident Adverse
Saadia Qazi1, Joseph M Massaro1, Michael L Chuang1
1From the National Heart, Lung and Blood Institute's Framingham Heart Study, MA (S.Q., J.M.M., M.L.C., R.B.D., U.H., C.J.O.); Department of Biostatistics, Boston University School of Public Health, MA (J.M.M., R.B.D.); Cardiovascular Imaging Core Laboratory, Beth Israel Deaconess Medical Center, Boston, MA (M.L.C.); Cardiac MR PET CT Program and Department of Radiology, Massachusetts General Hospital, Boston (U.H.); Cardiology Section, Boston Veteran's Administration Healthcare, MA (S.Q., C.J.O.); Division of Aging, Brigham and Women's Hospital, Boston, MA (S.Q.); and Harvard Medical School, Boston, MA (S.Q., U.H., C.J.O.).
Insights
Enlarged abdominal aorta diameters predict cardiovascular events in adults without existing disease. These aortic measurements improve risk prediction beyond standard cardiovascular disease factors.
Area of Science:
- Cardiovascular Imaging and Diagnostics
- Aortic Disease Research
- Predictive Modeling in Cardiology
Background:
- Adverse aortic remodeling, including dilation, is linked to cardiovascular disease (CVD) risk factors.
- Current prediction models for CVD events may not fully incorporate aortic dimensions.
Purpose of the Study:
- To assess if enlarged aortic diameters improve prediction of incident adverse CVD events.
- To determine if aortic measurements add predictive value beyond standard CVD risk factors in a community cohort.
Main Methods:
- Analysis of 3318 participants from Framingham Offspring and Third Generation Cohorts.
- Noncontrast thoracic and abdominal multidetector computed tomography (MDCT) scans were used to measure aortic diameters at four locations.
- Cox proportional hazards models were employed to assess the association between enlarged aortic segments and incident CVD events, adjusting for traditional risk factors.
Main Results:
- Over 8.8 years, 177 incident adverse CVD events occurred.
- Enlarged infrarenal abdominal aorta (HR=1.57) and lower abdominal aorta (HR=1.53) were significantly associated with increased CVD event hazard.
- Enlarged ascending and descending thoracic aorta were not significantly associated with CVD events.
Conclusions:
- Enlarged infrarenal and lower abdominal aorta diameters are independent predictors of incident adverse CVD events.
- These aortic measurements enhance CVD risk prediction beyond traditional risk factors in asymptomatic adults.
- MDCT-derived aortic dimensions offer valuable prognostic information for cardiovascular risk assessment.
Background:
Adverse aortic remodeling, such as dilation, is associated with multiple cardiovascular disease (CVD) risk factors. We sought to determine whether measures of enlarged aortic diameters improve prediction of incident adverse CVD events above standard CVD risk factors in a community-dwelling cohort.
Methods And Results:
Participants from the Framingham Offspring and Third Generation Cohorts (n=3318; aged 48.9±10.3 years), who underwent noncontrast thoracic and abdominal multidetector computed tomography during 2002 to 2005, had complete risk factor profiles, and were free of clinical CVD, were included in this study. Diameters were measured at 4 anatomically defined locations: the ascending thoracic aorta, descending thoracic aorta, the infrarenal abdominal aorta, and lower abdominal aorta. Adverse events comprised CVD death, myocardial infarction, coronary insufficiency, index admission for heart failure, and stroke. Each aortic segment was dichotomized as enlarged (diameter ≥upper 90th percentile for age, sex, and body surface area) or not enlarged; the hazard of an adverse event for an enlarged segment was determined using multivariable-adjusted Cox proportional hazards models. Over a mean 8.8±2.0 years of follow-up, there were 177 incident adverse CVD events. In models adjusted for traditional CVD risk factors, enlarged infrarenal abdominal aorta (hazard ratio=1.57; 95% confidence interval=1.06 to 2.32) and lower abdominal aorta (hazard ratio=1.53; 95% confidence interval=1.00 to 2.34) were associated with an increased hazard of CVD events. Enlarged ascending thoracic aorta and descending thoracic aorta were not significantly associated with CVD events.
Conclusions:
Among community-dwelling adults initially free of clinical CVD, enlarged infrarenal abdominal aorta and lower abdominal aorta, on noncontrast multidetector computed tomography scans, are independent predictors of incident adverse CVD events above traditional risk factors alone.
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