Abstract 2979: Association of Aortic Annular Dilatation With Aortic Regurgitation in Patients With Thoracic Aneurysms: The GenTAC Registry
Background: Aortic dilatation at the sinuses of Valsalva is known to increase the likelihood of aortic regurgitation (AR), but little is known of the relation of aortic annular diameter to AR in populations predisposed to AR such as patients with genetically-triggered thoracic aortic aneurysms
Methods: The NHLBI-sponsored GenTAC (Genetically-triggered Thoracic Aortic Aneurysms and Related Conditions) multi-center registry collects clinical and genetic information on patients with genetically triggered thoracic aortic aneurysms. We analyzed patients enrolled in the registry with diagnoses of Marfan (MFS), familial thoracic aortic aneurysm (FAA), bicuspid aortic valve and aneurysm (BAV), and Turner syndrome (TS). Aortic measurements were derived from clinical reports of echocardiograms. The severity of aortic regurgitation was coded as none, or 1+to 4+Only patients with native aortas and available imaging data were eligible for analysis
Results: Of 455 patients with native aortas enrolled in GenTAC with the diagnoses above, 198 patients (43% female, age 1– 88 [mean 21] years) had echocardio-graphic aortic annular and sinuses of Valsalva measurements available for analysis (Marfan=80, FAA=32, BAV=75, TS=11). In multivariate analysis, the prevalence of ≥2+ aortic regurgitation was associated with larger aortic annular diameter (OR=1.24 [95% CI 1.02–1.499, p=0.028] per standard deviation above diameter predicted for age and body surface area) but not with aortic diameter at the sinuses of Valsalva (p=0.52); in the same model, using the larger Marfan population as the reference group, patients with BAV and TS were more likely to have ≥2+ aortic regurgitation (OR 8.9 [3.2–24.7] and 7.1 [1.5–33.7], respectively, without difference for FAA (p=0.52).
Conclusion: In patients with thoracic aortic aneurysms, larger aortic annular size compared to that predicted for age and body size is associated with occurrence of ≥2+ AR, independent of aortic root diameter at the sinuses of Valsalva and the underlying condition causing aortic enlargement.