Severity of Ascending Aortic Degeneration in Patients With Chronic Obstructive Pulmonary Disease

Background Ascending aortic dilatation is associated with increased susceptibility to aortic events. Chronic obstructive pulmonary disease (COPD) may add to tissue degeneration and inflammation associated with the risk of increased aortic dilatation. We studied the characteristics and aortic wall degeneration of patients with COPD during ascending aortic dilatation. Methodology We enrolled 35 consecutive patients who underwent elective surgery for ascending aortic dilatation between February 2016 and November 2016. The patients were grouped according to the presence of COPD. The aortic diameters were measured for the aortic valve annulus, aortic root, sinotubular junction, ascending aorta, aortic arch, and descending aorta. An extensive analysis of ascending aortic wall histopathology was performed.  Results The patients with chronic obstructive pulmonary disease (COPD) (n=7) all had aortic valve regurgitation, while the aortic wall had more mucoid extracellular matrix accumulation, medial degeneration, elastic fiber fragmentation and loss, and adventitial fibrosis than those without COPD (5.7±1.1 vs. 4.3±1.0 point score units (PSU), p=0.006; 2.7±0.5 vs. 1.7±0.8 PSU, p=0.006; 4.5±1.2 vs. 3.3±1.2 PSU, p=0.034; and 0.5±0.5 vs. 0.1±0.3 PSU, p=0.023, respectively). Only the distal ascending aortic diameter slightly differed in patients with COPD vs. those without (36.5±3.3 vs. 32.2±3.8 mm, p=0.011), although increased aortic dilatation was otherwise present in both groups. Conclusions We identified a subgroup of patients with COPD who had increased aortic wall degeneration during ascending aortic dilatation. Risk stratification of aortic events in patients with COPD warrants further clarification.