title: Reference values for echocardiographic assessment of the diameter of the aortic root and ascending aorta spanning all age categories.
abstract: Thoracic aortic dilatation requires accurate and timely detection to prevent progression to thoracic aortic aneurysm and aortic dissection. The detection of thoracic aortic dilatation necessitates the availability of cut-off values for normal aortic diameters. Tools to evaluate aortic dimension above the root are scarce and inconsistent regarding age groups. The aim of this study was to provide reference values for aortic root and ascending aortic diameters on the basis of transthoracic echocardiographic measurements in a large cohort of children and adults. Diameters at the level of the sinuses of Valsalva (SoV) and ascending aorta (AA) were assessed with transthoracic echocardiography in 849 subjects (453 females, age range 1 to 85 years, mean 40.1 ± 21.3 years) and measured according to published guidelines. Linear regression analysis was applied to create nomograms, as well as equations for upper limits of normal and z-scores. SoV and AA diameters were strongly correlated with age, body surface area (BSA), and weight (r = 0.67 to 0.79, p <0.001 for all). Male subjects had significantly larger aortic dimensions at all levels in adulthood, even after BSA correction (p ≤0.004 for all age intervals). Gender-, age-, and BSA-specific upper limits of normal and z-score equations were developed from a multivariate regression model, which strongly predicts SoV and AA diameters (adjusted R(2) for SoV = 0.84 and 0.67 and for AA = 0.82 and 0.74, for male and female subjects, respectively). In conclusion, this study provides widely applicable reference values for thoracic aortic dilatation screening purposes. Age, BSA, and gender must be taken into account when assessing an individual patient.
authors.affiliation: Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium. Electronic address: laurence.campens@ugent.be.
authors.forename: Laurence
authors.initials: L
authors.lastname: Campens
authors.affiliation: Department of Cardiology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Laurent
authors.initials: L
authors.lastname: Demulier
authors.affiliation: Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Katya
authors.initials: K
authors.lastname: De Groote
authors.affiliation: Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Kristof
authors.initials: K
authors.lastname: Vandekerckhove
authors.affiliation: Department of Pediatric Cardiology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Daniël
authors.initials: D
authors.lastname: De Wolf
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York, New York.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Roman
authors.affiliation: Division of Cardiology, Weill Cornell Medical College, New York, New York.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Devereux
authors.affiliation: Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium.
authors.forename: Anne
authors.initials: A
authors.lastname: De Paepe
authors.affiliation: Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium; Department of Cardiology, Ghent University Hospital, Ghent, Belgium.
authors.forename: Julie
authors.initials: J
authors.lastname: De Backer
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000517:prevention & control; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging* / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D049451:Nomograms; D012016:Reference Values; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055815:Young Adult