Abstract P372: Increased Aortic Arch Width is an Independent Predictor of Incident Adverse Cardiovascular Disease Events: The Framingham Heart Study
Background: The aortic arch “unfolds” (radius of curvature increases) with greater age and excess burden of cardiovascular disease (CVD) risk factors. Aortic arch width (AAW, defined as the distance between the centroids of the ascending and descending aorta at the level of the main pulmonary artery bifurcation) is a simple, easily obtained measure of aortic geometry. We sought to determine whether AAW is an independent predictor of future adverse CVD events.
Methods: 3026 (1560 men) Framingham Offspring and Third Generation cohort members underwent thoracic multidetector computed tomography (MDCT) 2002-2005 and had complete risk factor profiles for analysis. AAW was measured by a single observer unaware of participant characteristics. Interobserver reproducibility for AAW was assessed in 100 participants. Adverse CVD events following MDCT were adjudicated by a panel of three physicians blinded to MDCT results. Incident CVD events included CVD death, myocardial infarction (MI), coronary insufficiency (CI), cerebrovascular accident (CVA), and index hospital admission for congestive heart failure (CHF-ia). Multivariable Cox proportional hazards models were used to determine the hazard of an adverse CVD event per 10mm of AAW, after adjustment for age, sex, smoking, systolic blood pressure, diabetes, total and HDL cholesterol.
Results: Mean ages of study participants were 50±11y for men and 52±10y for women. Mean AAW was 79±12mm in men and 70±10mm in women, p<0.0001. AAW measurement was highly reproducible (intraclass correlation coefficient=0.985). Over median 8.9-year follow-up there were 135 (4.5%) incident CVD events, including 49 MI (36%), 4 CI (3%), 42 CVA (31%), 34 CHF-ia (25%) and 6 CVD deaths (4%). Multivariable-adjusted Cox models indicated that greater AAW was associated with increased hazard of an incident CVD event (hazard ratio, HR=1.23/10mm; 95% confidence intervals, CI=1.04-1.46) after adjustment for age, sex and other CVD risk factors.
Conclusions: In a community-dwelling sample of middle-aged and older adults increased aortic arch width was an independent predictor of incident adverse CVD events over 8.9-year follow up. AAW is an easily performed and highly reproducible simple summary measure of aortic arch geometry that can be obtained from thoracic CT scans performed for clinical indications. Future studies are warranted to define the potential clinical value of AAW.
Author Disclosures: M.L. Chuang: None. P. Gona: None. R.M. Musgrave: None. S. Qazi: None. C.S. Fox: None. J.M. Massaro: None. U. Hoffmann: None. C.J. O'Donnell: None.
- © 2015 by American Heart Association, Inc.