Aortic Root Remodeling as an Indicator for Diastolic Dysfunction and Normative Ranges in Asians: Comparison and...

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Clinical Research

Background:

• Aortic root diameter (AoD) is a marker for cardiovascular risk and heart failure (HF).
• Normal reference ranges for AoD in Asians and their correlation with diastolic dysfunction (DD) are not well-established.
• Contemporary guidelines for DD assessment are underutilized in this demographic.

Purpose of the Study:

• To establish normal reference ranges for aortic root diameter (AoD) and indexed AoD (AoDi) in an Asian population.
• To explore the correlates of AoD/AoDi with cardiac structure, function, and N-terminal pro-brain B-type natriuretic peptide (Nt-ProBNP).
• To investigate the association of AoDi with left ventricular (LV) remodeling and diastolic dysfunction using current criteria.

Main Methods:

• Echocardiography was used to evaluate AoD/AoDi in 5343 asymptomatic Asian individuals.
• Cardiac structure, function, and Nt-ProBNP levels were assessed.
• A subset of 245 participants underwent multidetector computed tomography (MDCT) for aortic root geometry comparison.

Main Results:

• Greater AoD/AoDi was associated with older age, hypertension, higher diastolic blood pressure, and lower body fat.
• AoDi showed significant correlations with MDCT-derived measures, particularly at the aortic sinuses of Valsalva (r = 0.80).
• Indexed aortic diameter (AoDi) was linked to higher Nt-ProBNP, unfavorable LV remodeling, worse LV systolic function, LV hypertrophy, and abnormal LV diastolic indices, improving risk prediction (C-statistic from 0.71 to 0.84).

Conclusions:

• Echocardiography-defined aortic root dilation in Asians correlates with aging and hypertension.
• Indexed aortic diameter is a valuable indicator for identifying baseline diastolic dysfunction in this population.
• AoD/AoDi measurements provide incremental value for cardiovascular risk stratification.