Dilation of the Proximal Thoracic Aorta in an Asymptomatic Primary Prevention Population Undergoing Noncontrast Chest Computed Tomography

HomeCirculationVol. 139, No. 4Dilation of the Proximal Thoracic Aorta in an Asymptomatic Primary Prevention Population Undergoing Noncontrast Chest Computed Tomography Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBDilation of the Proximal Thoracic Aorta in an Asymptomatic Primary Prevention Population Undergoing Noncontrast Chest Computed Tomography Alaa Alashi, MD, Richard Lang, MD, Raul Seballos, MD, Steven Feinleib, MD, Roxanne Sukol, MD, Eric E Roselli, MD, Lars G. Svensson, MD, PhD, Vidyasagar Kalahasti, MD, Paul Schoenhagen, MD, Scott D. Flamm, MD, Brian P. Griffin, MD and Milind Y. Desai, MD Alaa AlashiAlaa Alashi Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH. , Richard LangRichard Lang Department of Preventive Medicine (R.L., R.S., S.F., R.S.), Cleveland Clinic, OH. , Raul SeballosRaul Seballos Department of Preventive Medicine (R.L., R.S., S.F., R.S.), Cleveland Clinic, OH. , Steven FeinleibSteven Feinleib Department of Preventive Medicine (R.L., R.S., S.F., R.S.), Cleveland Clinic, OH. , Roxanne SukolRoxanne Sukol Department of Preventive Medicine (R.L., R.S., S.F., R.S.), Cleveland Clinic, OH. , Eric E RoselliEric E Roselli Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH. , Lars G. SvenssonLars G. Svensson Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH. , Vidyasagar KalahastiVidyasagar Kalahasti Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH. Imaging Institute (V.K., P.S., S.D.F., M.Y.D.), Cleveland Clinic, OH. , Paul SchoenhagenPaul Schoenhagen Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH. Imaging Institute (V.K., P.S., S.D.F., M.Y.D.), Cleveland Clinic, OH. , Scott D. FlammScott D. Flamm Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH. Imaging Institute (V.K., P.S., S.D.F., M.Y.D.), Cleveland Clinic, OH. , Brian P. GriffinBrian P. Griffin Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH. and Milind Y. DesaiMilind Y. Desai Milind Y. Desai, MD, Department of Cardiovascular Medicine, Desk J1-5 Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195. Email E-mail Address: [email protected] Aorta Center, Heart and Vascular Institute (A.A., E.E.R., L.G.S., V.K., P.S., S.D.F., B.P.G., M.Y.D.), Cleveland Clinic, OH. Imaging Institute (V.K., P.S., S.D.F., M.Y.D.), Cleveland Clinic, OH. Originally published10 Nov 2018https://doi.org/10.1161/CIRCULATIONAHA.118.036191Circulation. 2019;139:557–558Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: November 10, 2018: Ahead of Print Thoracic aortic aneurysm is a potentially devastating disease that kills by dissection/rupture and exsanguination.1 However, it is difficult to estimate the true prevalence because many aneurysms are clinically silent and present as sudden death. Death by thoracic aortic aneurysm in the United States occurs at a rate of 3.1 (2.5 for women and 3.7 for males) per 100 000.1 In recent years, reduction in mortality is likely related to improved surveillance and surgical techniques.2 However, there remains a need for earlier detection. We sought to assess the rate of incidentally detected proximal ascending aortopathy in asymptomatic middle-age executives undergoing coronary artery calcium scoring at our institution.This was an observational study of 1806 consecutive asymptomatic executives undergoing a comprehensive evaluation in a primary prevention clinic between March 2016 and September 2017 after institutional review board approval with waiver of individual consent. No patient had documented aortic valve disease or aortopathy. Subjects underwent a prospectively triggered, axial noncontrast cardiac computed tomography scan (3 mm slice thickness, Siemens or Philips scanner). Along with coronary artery calcium scoring, aortic root (AR, measured cusp to commissure)and ascending aortic (AA) dimensions were measured using multiplanar reformatting.3 For both AR and AA, aortic size index (cm/m2, dimensions/body surface area) and aortic height index (AHI, cm/m2, aortic dimensions/height) were calculated.4 AR Z score was also calculated: measured diameter (cm)-predicted diameter (cm)/0.261.5 Predicted diameter was derived as: 2.423+(agex0.009)+(body surface areax0.461)–(sexx0.267), 1 for male and 2 for female. Thoracic aortic calcification (none severe) was recorded.3 Continuous variables are reported as mean±SD or median with interquartile range. Categorical variables are reported as percentage. Logistic regression analysis was performed to test the association between dilated aorta (AR or AA AHI >2.43 cm/m2) and potential predictors.4Baseline characteristics are shown in the Table, and CAC distribution was as expected. Dilated (>4 cm) AR and AA were observed in 346 (19%) and 183 (10%) participants, respectively (37 [2%)] had both dilated AR and AA). Three patients (0.2%) had both AR and AA >4.5 cm, none ≥5.5 cm. AR and AA ASI were high (>2.05 cm/m2) in 375 (21%) and 263 (15%) participants, respectively (226 [13%] had both AR and AA ASI >2.05 cm/m2).4 Similarly, AR and AA AHI were high (>2.43 cm/m2) in 285 (16%) and 223 (12%) participants, respectively (178 [10%] had both AR and AA AHI >2.43 cm/m2).4 AR Z score ≥2 was observed in 142 (8%) participants. Age (odds ratio, 1.02; 95% CI, 1.016–1.024), sex (odds ratio, 1.43; 95% CI, 1.13–1.82), body surface area (odds ratio, 1.01; 95% CI, 1.006–1.014), and hypertension (odds ratio, 1.29; 95% CI, 1.02–1.65) were independently associated with high AR and AA AHI (all P<0.01). On echocardiography, 8 participants had a bicuspid aortic valve and dilated AR.In asymptomatic middle-age subjects who underwent a chest computed tomography scan, ≤16% had a dilated AR, indexed to height. These findings demonstrate the potential utility of a noncontrast computed tomography scan in providing information related to thoracic aortopathy, in addition to coronary artery calcium scoring.Table. Relevant Data in the Study CohortVariableTotal (N=1806)Age, y55±12 (range, 45–70)Male sex1377 (76%)Race White1596 (88%) Black33 (2%) Asian31 (2%) Multiracial30 (2%) Unknown/declined116 (6%)Height, m1.76±1Body surface area, m22.0±0.7Hypertension418 (23%)Smoking history168 (9%)Diabetes mellitus80 (4%)Hyperlipidemia837 (46%)Atherosclerotic cardiovascular disease 10-y risk5.5±5%, median 4.0% (interquartile range, 2.0–7.3)β-Blockers96 (5%)Angiotensin-converting enzyme inhibitors/ angiotensin receptor blockers312 (17%)Coronary artery calcium score92±337, median 0 (interquartile range, 0–44)Coronary artery calcium score >0972 (54%)Aortic root diameter3.9±1.5 cmAortic root diameter ≥4.5 cm33 (2%)Aortic root diameter ≥5 cm2 (0.1%)Aortic root Z score0.49±1.9, median 0.55 (interquartile range, 0.14–1.07)Aortic root size index, cm/m21.86±0.3Aortic root height index, cm/m22.3±0.6Ascending aortic diameter, cm3.6±0.5Ascending aortic diameter ≥4.5 cm15 (1%)Aortic root diameter ≥5 cm1 (0.1%)Ascending aortic height index, cm/m22.3±0.7Ascending aorta size index, cm/m21.80±0.2Proximal thoracic aortic calcification None1590 (88%) Trivial96 (5%) Mild109 (6%) Moderate11 (0.6%) Severe/porcelain aorta0AcknowledgmentsDr Desai is supported by the Haslam Family-endowed chair in cardiovascular medicine.DisclosuresNone.Footnoteshttps://www.ahajournals.org/journal/circData sharing: The data, analytic methods, and study materials will not be made available to other researchers for purposes of reproducing the results or replicating the procedure.Milind Y. Desai, MD, Department of Cardiovascular Medicine, Desk J1-5 Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195. Email [email protected]orgReferences1. 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January 22, 2019Vol 139, Issue 4 Advertisement Article InformationMetrics © 2018 American Heart Association, Inc.https://doi.org/10.1161/CIRCULATIONAHA.118.036191PMID: 30586688 Originally publishedNovember 10, 2018 Keywordscomputed tomography scanaortopathyprimary preventionPDF download Advertisement SubjectsAneurysm