Abstract 13006: Computed Tomographic Indexing Aortic Root Area to Height Provides Incremental Prognostic Utility in Patients With Trileaflet Aortic Valve and Dilated Aortic Root
Background: We sought to assess predictors of long-term outcomes in patients with dilated aortic roots, but with trileaflet aortic valves (TAV). We also sought to assess incremental prognostic utility of indexing aortic root area to height.
Methods: We studied 584 consecutive patients (61±14 years, 89% men) with TAV & dilated aortic root (≥4 cm) that underwent echo & gated contrast-enhanced computed tomography (CT) of thoracic aorta between 2003-7. Clinical, echo & CT data were recorded. A ratio of aortic root area over height was calculated (cm2/m). A composite endpoint of death & dissection were recorded.
Results: The mean Euroscore & ejection fraction were 9±5 & 55±9%; 7% had Marfan’s syndrome, 18% had ≥III+ aortic regurgitation (AR) & 3% had AV gradient ≥40 mm Hg. Aortic root sizes (on CT) were as follows: 4-4.5 cm (50%), 4.6-4.9 cm (28%), 5-5.5 cm (16%), >5.5 cm (6%). Aortic root area/height ratio was abnormal (≥10) in 27% patients. During a follow up of 4.6±4 years, 238 (41%) patients underwent ascending aortic surgery (+/- combination coronary bypass &/or AV replacement), while 104 (18%) met the composite endpoint (3% had an aortic dissection). On multivariable Cox Proportional Hazard Analysis, increasing age (Hazard ratio or HR 1.06), Marfan’s syndrome (HR 2.37), aortic root area/height ratio (HR 1.74) and aortic surgery (HR 0.86) were independently associated with composite endpoint (all p<0.01). Aortic root area/height ratio ≥10 predicted composite endpoint (Figure). Addition of aortic root dimensions to Euroscore resulted in improved risk stratification for death or dissection [net reclassification improvement or NRI 0.07 (0.009-0.12], p=0.02)]. However, addition of aortic root area/height ratio to Euroscore further improved risk stratification [NRI 0.24 (0.04-0.44, p=0.01)].
Conclusion: In TAV patients with dilated aortic root, ratio of aortic root area/height provides independent & improved stratification for prediction of death or dissection.
Author Disclosures: A. Masri: None. V. Kalahasti: None. L.G. Svensson: None. E.E. Roselli: None. D. Johnston: None. D. Hammer: None. R.A. Grimm: None. P. Schoenhagen: None. B.P. Griffin: None. M.Y. Desai: None.
- © 2014 by American Heart Association, Inc.