Study of risk factors for ascending aortic dilatation in different age groups using cardiac ultrasound indices

Background: Bileaflet aortic valve (BAV) is a common congenital heart abnormality, associated with ascending aortic dilatation and a higher risk of aneurysm. Imaging techniques have been crucial in monitoring these patients, with cardiac ultrasound being increasingly used due to its noninvasive nature and high temporal resolution. However, most studies have focused on valve morphology and less on the role of age in hemodynamic changes. This study aims to analyze the risk factors for ascending aortic dilatation using cardiac ultrasound indices in BAV patients across different age groups. Methods: We included 300 patients diagnosed with BAV at the First Central Hospital of Baoding, with cardiac ultrasound data compared between those with and without aortic dilatation. Multifactorial analysis was performed to identify independent predictors of ascending aortic dilatation, focusing on age, hemodynamic load, and clinical comorbidities. Results: Age was significantly associated with peak transvalvular pressure difference and ascending aortic internal diameter. The analysis showed that in young patients, aortic dilatation was mainly linked to valve-derived hemodynamic abnormalities, whereas in middle-aged patients, risk factors included hemodynamic load and diabetes. In older patients, the primary factors were smoking-induced oxidative stress and degenerative lesions. Age was found to significantly affect the predictive efficacy of peak transvalvular pressure difference. Conclusion: This study highlights age-specific differences in the mechanisms of ascending aortic dilatation. In young patients, valve dysfunction predominates; in middle-aged individuals, metabolic diseases such as diabetes become important risk factors; and in the elderly, long-term smoking and degenerative changes dominate. The findings suggest the importance of individualized risk assessment based on age for better management of ascending aortic dilatation in clinical practice.