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Non-Linear Size Effects and Episodic Progression in the Ascending Aorta
Carlos Alberto Campello Jorge1,2, Prabhvir S Marway1,2, Gregory Spahlinger1,2
1Department of Radiology, University of Michigan.
Medrxiv : the Preprint Server for Health Sciences
|September 26, 2025
Summary
Ascending aortic growth is non-linear and episodic, not continuous. Baseline size and growth show a U-shaped relationship, with nearly a quarter of patients experiencing growth bursts.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging Analysis
Background:
- Predicting ascending aortic (AsAo) growth is complex.
- Conventional models assume linear, continuous growth, potentially oversimplifying disease progression.
Purpose of the Study:
- Evaluate the non-linear association between baseline AsAo size and subsequent growth.
- Determine if patient growth trajectories are continuous or episodic.
Main Methods:
- Retrospective study (2012-2024) of 3,315 patients with ≥2 imaging scans.
- Used multivariable regression and generalized additive models (GAMs) to analyze baseline Z-score and growth.
- Classified longitudinal phenotypes (Stable, Stable-with-Noise, Continuous, Episodic) in a sub-cohort of 1,055 patients.
Main Results:
- Baseline Z-score showed a significant U-shaped association with growth (p<0.001).
- Growth was higher at both small (Z<0) and severely dilated (Z>5) baseline sizes.
- 50.4% Stable, 21.6% Stable-with-Noise, 5.4% Continuous, 22.6% Episodic growth.
- Among those with measurable growth, 81% exhibited episodic growth.
Conclusions:
- AsAo growth is better described by non-linear, punctuated patterns than linear, continuous ones.
- Episodic growth is common, particularly in patients with measurable aortic enlargement.
- Findings suggest re-evaluating surveillance strategies and risk communication for thoracic aortic disease.
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