Cited by 287Aortic Disease and Treatment ApproachesAortic aneurysm repair treatmentsConnective tissue disorders research

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Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm

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Zafar, Mohammad A., Li, Yupeng, Rizzo, John A., Charilaou, Paris, Saeyeldin, Ayman, Velasquez, Camilo A., Mansour, Ahmed M., Bin Mahmood, Syed Usman, Ma, Wei-Guo, Brownstein, Adam J., Tranquilli, Maryann, Dumfarth, Julia, Theodoropoulos, Panagiotis, Thombre, Kabir, Tanweer, Maryam, Erben, Young, Peterss, Sven, Ziganshin, Bulat A., Elefteriades, John A.·2018·The Journal of Thoracic and Cardiovascular Surgery

DOI 10.1016/j.jtcvs.2017.10.140

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Abstract

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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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: Zafar, Mohammad A.
Li, Yupeng
Rizzo, John A.
Charilaou, Paris
Saeyeldin, Ayman
Ma, Wei-Guo
Brownstein, Adam J.
Tranquilli, Maryann
Dumfarth, Julia
Theodoropoulos, Panagiotis
Erben, Young
Peterss, Sven
Ziganshin, Bulat A.
Elefteriades, John A.
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)
DOI: 10.1016/j.jtcvs.2017.10.140
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
FWCI: 12.44
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 731 d)
Locations: Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Aortic Disease and Treatment Approaches
Health Sciences › Medicine › Surgery › 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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Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm

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