Rate of Ascending Aortic Enlargement in a Large Echocardiographic Cohort: Associated Risk Factors and Adverse Aortic Events

Background: Understanding ascending aortic aneurysm growth and associated risk factors is critical to advising appropriate echocardiographic follow-up intervals for patients. The aim of this study was to identify aortic aneurysm growth rate on serial echocardiography as well as the clinical and demographic variables that contribute to baseline aortic size and subsequent aortic growth.

Methods: Patients identified with ascending aortic aneurysms and undergoing serial echocardiograms within 5 years were evaluated. Ascending aortic size was measured as part of routine echocardiographic examinations. Clinical and demographic variables including aortic valve type (trileaflet, bicuspid, or prosthetic) were evaluated for association with baseline aortic size as well as with aortic progression rate. Clinical events including aortic dissection and elective or emergent surgical repair were recorded.

Results: A total of 3,639 patients were identified (78% men; median age, 69 years), 175 (4.8%) with bicuspid valves and 206 (5.6%) with prior aortic valve replacement. Patients with larger aortas at baseline were older, with higher tobacco use and prior prosthetic valves. Over a mean of 2.4 years, aortic growth was observed and differed by valve type (trileaflet valve, 0.08 mm/y; bicuspid valve, 0.4 mm/y; P < .001). In six patients who developed aortic dissection, the estimated average annual growth rate was 0.98 mm/y.

Conclusions: In a large echocardiographic cohort, aortic aneurysm growth rate was 0.08 mm/y, though it was higher in patients with bicuspid valves (0.4 mm/y), but initial aortic size did not correlate with change in the aortic progression rate. These data may help inform recommended echocardiographic surveillance intervals.