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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 (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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Metadata
- 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
- 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 › 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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