title: Aortic root remodeling and risk of heart failure in the Framingham Heart study.
abstract: OBJECTIVE
  The aim of this study was to investigate the association between aortic root remodeling and incident heart failure (HF).
  
  
  BACKGROUND
  Age-associated increases in aortic root diameter (AoD) might be associated with arterial stiffening, afterload changes, cardiac remodeling, and the development of HF.
  
  
  METHODS
  The study sample consisted of participants of the Framingham Heart Study Original and Offspring cohorts who underwent serial echocardiographic measurements of AoD and continuous surveillance for new-onset HF. The AoD was measured at baseline, and the change in AoD between 8-year examination cycles was calculated. Pooled repeated observations (total 13,605 person-observations) in multivariable Cox regression analyses were used to relate baseline AoD and change in AoD to the incidence of HF on follow-up. Models were adjusted for known HF risk factors (age, sex, body mass index, blood pressure, hypertension treatment, diabetes, smoking, prior myocardial infarction, and valve disease).
  
  
  RESULTS
  With adjustment for clinical risk factors, the risk of incident HF increased with greater AoD at baseline (hazard ratio: 1.19/1 SD; 95% confidence interval: 1.07 to 1.33) as well as increases in AoD over 8 years (hazard ratio: 1.20/1 SD; 95% confidence interval: 1.04 to 1.38). The AoD correlated with left ventricular mass (r = 0.50; p < 0.001). After adjustment for left ventricular mass in addition to clinical risk factors, the association of AoD with incident HF was rendered nonsignificant.
  
  
  CONCLUSIONS
  Aortic root remodeling is associated with future risk of HF among middle-aged and older adults in the community, potentially because it reflects parallel ventricular-vascular remodeling in those with an enlarged aortic root. Additional studies are warranted to confirm our findings.
authors.forename: Carolyn S P
authors.initials: CS
authors.lastname: Lam
authors.forename: Philimon
authors.initials: P
authors.lastname: Gona
authors.forename: Martin G
authors.initials: MG
authors.lastname: Larson
authors.forename: Jayashri
authors.initials: J
authors.lastname: Aragam
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Lee
authors.forename: Gary F
authors.initials: GF
authors.lastname: Mitchell
authors.forename: Daniel
authors.initials: D
authors.lastname: Levy
authors.forename: Susan
authors.initials: S
authors.lastname: Cheng
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.forename: Ramachandran S
authors.initials: RS
authors.lastname: Vasan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000473:pathology / Q000502:physiology*; D001018:Aortic Diseases / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D066253:Vascular Remodeling / Q000502:physiology*; D059289:Vascular Stiffness / Q000502:physiology