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Correlation of aortic root dimensions and mortality in acute heart failure: A nationwide prospective cohort study

Zeming Zhou¹, Wei Wang^1,2, Lili Tian³

¹National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China.

|September 19, 2024

Insights

Lower aortic root dimensions (ARD) indexed to body mass index (BMI) are linked to reduced mortality in acute heart failure (AHF) patients. Sex-specific differences in this association were also observed.

Area of Science:

Cardiology
Cardiovascular Research
Heart Failure Management

Background:

Increased aortic root dimensions (ARD) are associated with higher cardiovascular mortality in the general population.
Limited evidence exists on the association between ARD and mortality specifically in patients with acute heart failure (AHF).

Purpose of the Study:

To investigate the association between body mass index (BMI)-indexed ARD and mortality in patients with AHF.
To explore potential sex-specific differences in the relationship between BMI-indexed ARD and mortality.

Main Methods:

A nationwide prospective cohort study (China Patient-Centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study) included 2125 AHF patients.
Aortic root dimensions (ARD) were measured via echocardiography and indexed to BMI.
Cox proportional hazard models and restricted cubic splines were used to analyze the association between BMI-indexed ARD and mortality, considering competing risks and sex differences.

Main Results:

Lower BMI-indexed ARD was significantly associated with reduced cardiovascular and all-cause mortality compared to higher BMI-indexed ARD.
The lowest tertile of BMI-indexed ARD showed a lower risk of cardiovascular mortality in all populations and both sexes.
A linear relationship between BMI-indexed ARD and mortality was observed in males, whereas a 'J'-shaped relationship was found in females.

Conclusions:

Lower BMI-indexed ARD is associated with decreased mortality risk in AHF patients.
Significant sex-based discrepancies exist in the relationship between BMI-indexed ARD and mortality.
These findings aid in identifying potential mortality risks in AHF patients.

Read full analysis

Abstract

Background:

An association between increased aortic root dimensions (ARD) and elevated risk of cardiovascular mortality has been reported in the general population. However, evidence regarding the association between ARD and mortality in patients with acute heart failure (AHF) is limited.

Methods:

In a nationwide prospective cohort of the China Patient-Centered Evaluative Assessment of Cardiac Events Prospective Heart Failure Study, ARD was measured during diastole using echocardiography and indexed to body mass index (BMI). Cox proportional hazard models were used to validate the association between BMI-indexed ARD and mortality. Additionally, the relationship between BMI-indexed ARD and mortality was presented using restricted cubic spline in all populations, and both sexes.

Results:

A total of 2125 participants with ARD were included in the final analysis, among of 38.4 % were women, with a median age of 67 years. Over a median follow-up period of 54.4 (interquartile range: 30.1 to 59.7) months, 895 deaths occurred, with 750 attributed to cardiovascular causes and 145 to non-cardiovascular causes. Compared to the highest tertile group of BMI-indexed ARD, the lowest tertile group had a lower risk of cardiovascular mortality (hazard ratio [HR], 0.71; 95 % confidence interval [CI], 0.58 to 0.87; P < 0.001) and all-cause mortality (HR, 0.68; 95 % CI, 0.56 to 0.81; P < 0.001). Similarly, the middle tertile group also had a lower risk of cardiovascular mortality (HR, 0.78; 95 % CI, 0.65 to 0.93; P = 0.007) and all-cause mortality (HR, 0.75; 95 % CI, 0.63 to 0.89; P < 0.001). Considering the competing risks, the lowest BMI-indexed ARD groups showed a significant mortality risk of cardiovascular mortality in all populations, and both sexes. Moreover, the relationship between BMI-indexed ARD and mortality was linear in males, while a "J" shaped relationship was observed in females.

Conclusion:

Lower BMI-indexed ARD was associated with a decreased risk of all-cause and cardiovascular mortality than those with higher BMI-indexed ARD in AHF. Additionally, a discrepancy was observed between the sexes in the relationship between BMI-indexed ARD and mortality. These findings contribute to the prompt identification of potential mortality risks in patients with AHF.

Keywords:

Acute heart failure Aortic root Echocardiography Mortality Predictive Sex

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