Site-specific analysis of thoracic aortic aneurysm and cardiovascular mortality: Insights from the National Echo Database Australia
Listed in
This article is not in any list yet, why not save it to one of your lists.Abstract
Background
Aortic diameter remains the most utilised criterion for considering surgical correction. In uncomplicated cases guidelines do not differentiate between the size of aneurysms at the root and ascending aorta. In order to improve practice, greater understanding of site-specific TAA is needed. A nationwide echocardiographic dataset linked to mortality outcomes was examined to determine how TAA affects cardiovascular (CVD) mortality.
Methods
The National Echo Database Australia (NEDA) was examined for aortic dimensions at the sinuses of Valsalva (SoV), sinotubular junction (STJ) and ascending aorta (AscAo). Patients were stratified according to absolute aortic diameters and grouped as normal (<4cm), mild (4.0-4.5cm), moderate (4.5-5cm) and severely (>5cm) dilated at the prescribed thoracic aortic sites. Mortality data was linked from the National Death Index.
Results
477,501 echocardiographs from 175,158 patients with 2,897,357 patient-years of follow-up were included. Severe TAA at any site increased likelihood of 10-year CVD mortality compared to normal aortic diameters (31% vs. 14%, p<0.0001), with incremental increase in probability of CVD death when moving from the proximal to distal ascending aorta; CVD mortality at SoV 30% (HR 1.79; CI 1.2-2.67; p=0.004), STJ 41% (HR 1.91; CI 1.11-3.29; p=0.002) and AscAo 45% (HR 3.96; CI 2.06-7.64; p<0.001).
Conclusions
Severe TAA increases the probability of cardiovascular mortality. Given the low event rate of aortic death (0.2%) this is not solely explained by increased dissection risk. Interestingly, there is a doubling of CVD mortality likelihood when moving from the proximal to distal ascending aorta. These results suggest those with severe AscAo dilatation may be at higher CVD risk compared to those with aortic root aneurysms, identifying new considerations for risk stratification and surgical management.
