Aortic Root Remodeling as an Indicator for Diastolic Dysfunction and Normative Ranges in Asians: Comparison and Validation with Multidetector Computed Tomography

• Main Authors: Lawrence Yu-min Liu, Chun-Ho Yun, Jen-Yuan Kuo, Yau-Huei Lai, Kuo-Tzu Sung, Po-Jung Yuan, Jui-Peng Tsai, Wen-Hung Huang, Yueh-Hung Lin, Ta-Chuan Hung, Ying-Ju Chen, Cheng-Huang Su, Cheng-Ting Tsai, Hung-I Yeh, Chung-Lieh Hung
• Format: Article
• Language: English
• Published: MDPI AG 2020-09-01
• Series: Diagnostics
• Subjects: aortic root diameter; heart failure; diastolic indices; multidetector computed tomography (MDCT); N-terminal pro-brain B-type natriuretic peptide (Nt-ProBNP)
• Online Access: https://www.mdpi.com/2075-4418/10/9/712

Background: The aortic root diameter (AoD) has been shown to be a marker of cardiovascular risk and heart failure (HF). Data regarding the normal reference ranges in Asians and their correlates with diastolic dysfunction using contemporary guidelines remain largely unexplored. Methods: Among 5343 consecutive population-based asymptomatic Asians with echocardiography evaluations for aortic root diameter (without/with indexing, presented as AoD/AoDi) were related to cardiac structure/function and N-terminal pro-brain B-type natriuretic peptide (Nt-ProBNP), with 245 participants compared with multidetector computed tomography (MDCT)-based aortic root geometry. Results: Advanced age, hypertension, higher diastolic blood pressure, and lower body fat all contributed to greater AoD/AoDi. The highest correlation between echo-based aortic diameter and the MDCT-derived measures was found at the level of the aortic sinuses of Valsalva (r = 0.80, <i>p</i> < 0.001). Age- and sex-stratified normative ranges of AoD/AoDi were provided in 3646 healthy participants. Multivariate linear regressions showed that AoDi was associated with a higher NT-proBNP, more unfavorable left ventricular (LV) remodeling, worsened LV systolic annular velocity (TDI-s′), a higher probability of presenting with LV hypertrophy, and abnormal LV diastolic indices except tricuspid regurgitation velocity by contemporary diastolic dysfunction (DD) criteria (all <i>p</i> < 0.05). AoDi superimposed on key clinical variables significantly expanded C-statistic from 0.71 to 0.84 (<i>p</i> for ∆AUROC: < 0.001). These associations were broadly weaker for AoD. Conclusion: In our large asymptomatic Asian population, echocardiography-defined aortic root dilation was associated with aging and hypertension and were correlated modestly with computed tomography measures. A larger indexed aortic diameter appeared to be a useful indicator in identifying baseline abnormal diastolic dysfunction.