Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm
Open accessAbstract
Background In international guidelines, risk estimation for thoracic ascending aortic aneurysm (TAAA) is based on aortic diameter. We previously introduced the aortic size index (ASI), defined as aortic size/body surface area (BSA), as a predictor of aortic dissection, rupture, and death. However, weight might not contribute substantially to aortic size and growth. We seek to evaluate the height-based aortic height index (AHI) versus ASI for risk estimation and revisit our natural history calculations.Methods Aortic diameters and long-term complications of 780 patients with TAAA were analyzed. Growth rate estimates, yearly complication rates, and survival were assessed. Risk stratification was performed using regression models. The predictive value of AHI and ASI was compared.Results Patients were stratified into 4 categories of yearly risk of complications based on their ASI and AHI. ASIs (cm/m 2) of ≤2.05, 2.08 to 2.95, 3.00 to 3.95 and ≥4, and AHIs (cm/m) of ≤2.43, 2.44 to 3.17, 3.21 to 4.06, and ≥4.1 were associated with a 4%, 7%, 12%, and 18% average yearly risk of complications, respectively. Five-year complication-free survival was progressively worse with increasing ASI and AHI. Both ASI and AHI were shown to be significant predictors of complications (P < .05). AHI categories 3.05 to 3.69, 3.70 to 4.34, and ≥4.35 cm/m were associated with a significantly increased risk of complications (P < .05). The overall fit of the model using AHI was modestly superior according to the concordance statistic.Conclusions Compared with indices including weight, the simpler height-based ratio (excluding weight and BSA calculations) yields satisfactory results for evaluating the risk of natural complications in patients with TAAA.
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The most frequently used indexing methods are the Z-score, the aortic height index (AHI), and the aortic size index (ASI).
“The most frequently used indexing methods are the Z-score (Z, dimensionless unit indicating the number of standard deviations from the population mean), the aortic height index (AHI, aortic diameter in millimeters divided by body length in meters), and the aortic size index (ASI, aortic diameter in centimeters divided by body surface area (BSA) per square meters) (Table 12).232,233,441-443”
From Clinical practice guidelines for the care of girls and women with Turner syndrome. (2024) · cites this paper as [443]
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Bicuspid aortopathy does not require earlier surgical intervention
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Echocardiographic Evaluation of the Thoracic Aorta: Tips and Pitfalls
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Relationship Between Length and Curvature of Ascending Aorta and Type a Dissection
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Cardiac surgery following transcatheter aortic valve replacement
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Mitral Regurgitation in Female Patients: Sex Differences and Disparities
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Ascending aortic geometry and its relationship to the biomechanical properties of aortic tissue
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Stiffness matters: Improved failure risk assessment of ascending thoracic aortic aneurysms
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“Getting beyond diameter”: when to replace the aorta?
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Understanding Thoracic Aortic Disease in Women
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Sex-Related Differences After Proximal Aortic Surgery: Outcome Analysis of 1773 Consecutive Patients
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Deep Learning Improves the Temporal Reproducibility of Aortic Measurement
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Performance of a deep learning tool to detect missed aortic dilatation in a large chest CT cohort
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Ascending aneurysmectomy: Should we shift to the left?
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Aortic size distribution among normal, hypertension, bicuspid, and Marfan populations
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Predicting Thoracic Aortic Dissection in a Diverse Biobank Using a Polygenic Risk Score
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Coding and Non-Coding Transcriptomic Landscape of Aortic Complications in Marfan Syndrome
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Elective ascending aortic aneurysm repair outcomes in a nationwide US cohort
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Proximal aortic aneurysms: correlation of maximum aortic diameter and aortic wall thickness
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Portilla-Fernández, E., Klarin, D. M., Hwang, S., Biggs, M. L., Bis, J. C., Weiß, S., Rospleszcz, S., Natarajan, P., Hoffmann, U., Rogers, I. S., et al. (2022) · Human Molecular Genetics · doi:10.1093/hmg/ddac051 · Cited by 10 · see citing works
Adult Patients With Marfan Syndrome and Ascending Aortic Surgery
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The natural history of aortic root aneurysms
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New indicators for systematic assessment of aortic morphology: a narrative review
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Aneurysms of the aorta: ascending, thoracic, and abdominal and their management
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Development of a multivariable prediction model for patient-adjusted aortic risk morphology
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- Authors
- Zafar, M. A., Li, Y., Rizzo, J. A., Charilaou, P., Saeyeldin, A., Velasquez, C. A., Mansour, A. M., Bin Mahmood, S. U., Ma, W.-G., Brownstein, A. J., Tranquilli, M., Dumfarth, J., Theodoropoulos, P., Thombre, K., Tanweer, M., Erben, Y., Peterss, S., Ziganshin, B. A., & Elefteriades, J. A.
- Affiliations
- Yale New Haven Hospital (US)
- Rowan University (US)
- Stony Brook University (US)
- Yale University (US)
- Ludwig-Maximilians-Universität München (DE)
- Corresponding author
- Elefteriades, John A.
- ORCID
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2018-05
- Volume
- 155
- Issue
- 5
- Pages
- 1938-1950
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W2773369012
- Cited by
- 287
- References
- 28
- Citations by year
- 2026: 42 · 2025: 42 · 2024: 35 · 2023: 38 · 2022: 38 · 2021: 36 · 2020: 24 · 2019: 17 · 2018: 11 · 2017: 3
- FWCI
- 12.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic aneurysm repair treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Connective tissue disorders research
- Keywords
- aortic size index, body surface area, risk stratification, aortic diameter, aortic dissection, aneurysm rupture, natural history (disease), aneurysm growth rate, complication-free survival
- MeSH terms
- Progression-Free Survival, Adolescent, Adult, Aged, Aged, 80 and over, Body Height, Body Surface Area, Decision Support Techniques, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Retrospective Studies, Risk Factors, Time Factors, Databases, Factual, Aortic Aneurysm, Thoracic, Disease Progression, Risk Assessment, Young Adult
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