Related Experiment Video
Updated: Aug 21, 2025
Measurement of Pulse Propagation Velocity, Distensibility and Strain in an Abdominal Aortic Aneurysm Mouse Model
Published on: February 23, 2020
Development of a Prediction Model for Ascending Aortic Diameter Among Asymptomatic Individuals
James P Pirruccello1,2,3,4,5, Honghuang Lin6,7,8, Shaan Khurshid1,2,3,4
1Cardiology Division, Massachusetts General Hospital, Boston, Massachusetts.
Insights
A new clinical score can estimate ascending aortic diameter using common data, aiding in early detection of aortic aneurysms. This tool helps identify individuals needing further imaging for potential life-threatening thoracic aortic disease.
Area of Science:
- Cardiovascular Medicine
- Radiology
- Medical Informatics
Background:
- Ascending thoracic aortic disease is a significant cause of sudden death.
- Most aortic aneurysms are incidentally discovered, highlighting a need for proactive detection methods.
Purpose of the Study:
- To develop and validate a clinical score for estimating ascending aortic diameter.
- To improve early identification of individuals at risk for thoracic aortic disease.
Main Methods:
- Utilized UK Biobank cohort data (n=30,018) for score derivation and internal validation (n=6681).
- Externally validated the score in the Framingham Heart Study (FHS) cohort (n=1367) and Mass General Brigham (MGB) network (n=50,768).
- Employed hierarchical group LASSO regression with demographic and clinical variables.
Main Results:
- The developed score explained 28.2%-32.6% of the variance in ascending aortic diameter across validation cohorts.
- Achieved areas under the receiver operator characteristic curve of 0.770-0.813 for detecting diameter ≥4 cm.
- Demonstrated high specificity (96.2%-99.2%) but variable sensitivity (8.9%-18.8%) at a threshold of 3.537.
Conclusions:
- A validated clinical prediction model for ascending aortic diameter was developed using readily available data.
- Further research is required to optimize the model and assess its impact on patient outcomes.
- The score shows potential for risk stratification in thoracic aortic disease.
Importance:
Ascending thoracic aortic disease is an important cause of sudden death in the US, yet most aortic aneurysms are identified incidentally.
Objective:
To develop and validate a clinical score to estimate ascending aortic diameter.
Design, Setting, And Participants:
Using an ongoing magnetic resonance imaging substudy of the UK Biobank cohort study, which had enrolled participants from 2006 through 2010, score derivation was performed in 30 018 participants and internal validation in an additional 6681. External validation was performed in 1367 participants from the Framingham Heart Study (FHS) offspring cohort who had undergone computed tomography from 2002 through 2005, and in 50 768 individuals who had undergone transthoracic echocardiography in the Community Care Cohort Project, a retrospective hospital-based cohort of longitudinal primary care patients in the Mass General Brigham (MGB) network between 2001-2018.
Exposures:
Demographic and clinical variables (11 covariates that would not independently prompt thoracic imaging).
Main Outcomes And Measures:
Ascending aortic diameter was modeled with hierarchical group least absolute shrinkage and selection operator (LASSO) regression. Correlation between estimated and measured diameter and performance for identifying diameter 4.0 cm or greater were assessed.
Results:
The 30 018-participant training cohort (52% women), were a median age of 65.1 years (IQR, 58.6-70.6 years). The mean (SD) ascending aortic diameter was 3.04 (0.31) cm for women and 3.32 (0.34) cm for men. A score to estimate ascending aortic diameter explained 28.2% of the variance in aortic diameter in the UK Biobank validation cohort (95% CI, 26.4%-30.0%), 30.8% in the FHS cohort (95% CI, 26.8%-34.9%), and 32.6% in the MGB cohort (95% CI, 31.9%-33.2%). For detecting individuals with an ascending aortic diameter of 4 cm or greater, the score had an area under the receiver operator characteristic curve of 0.770 (95% CI, 0.737-0.803) in the UK Biobank, 0.813 (95% CI, 0.772-0.854) in the FHS, and 0.766 (95% CI, 0.757-0.774) in the MGB cohorts, although the model significantly overestimated or underestimated aortic diameter in external validation. Using a fixed-score threshold of 3.537, 9.7 people in UK Biobank, 1.8 in the FHS, and 4.6 in the MGB cohorts would need imaging to confirm 1 individual with an ascending aortic diameter of 4 cm or greater. The sensitivity at that threshold was 8.9% in the UK Biobank, 11.3% in the FHS, and 18.8% in the MGB cohorts, with specificities of 98.1%, 99.2%, and 96.2%, respectively.
Conclusions And Relevance:
A prediction model based on common clinically available data was derived and validated to predict ascending aortic diameter. Further research is needed to optimize the prediction model and to determine whether its use is associated with improved outcomes.
