Prevalence of proximal ascending aorta and target organ damage in hypertensive patients: the multicentric ARGO-SIIA project (Aortic RemodellinG in hypertensiOn of the Italian Society of Hypertension)

Aim: The aim of this study was to assess the prevalence of ascending aortic dilatation and to evaluate the possible association between proximal aorta dilatation and structural or functional markers of cardiac organ damage in hypertensive patients. Background: Dilatation of the sinus of valsalva (SoV) is a common finding in clinical practice and it is associated with an increased cardiovascular risk in hypertensive patients: less is known about the dilatation prevalence of the subsequent portion, the proper ascending aorta and its relationship with cardiovascular organ damage. Methods: This multicentric study included 582 hypertensive and 104 normotensive control individuals. All individuals underwent clinical evaluation and two-dimensional transthoracic echocardiography focused on the evaluation of the aorta. Aortic diameters at three levels were measured: SoV, sinotubular junction and ascending aorta. Results: The prevalence of ascending aorta dilatation was 13%. Patients with ascending aorta dilatation were on average 10 years older than hypertensive patients without aortic dilatation and control individuals. Left ventricular mass was significantly increased (P < 0.0001) in patients with ascending aorta dilatation with (113.29 ± 3 g/m2) or without (109.16 ± 3 g/m2) SoV dilatation compared with patients with isolated SoV dilatation (98.80 ± 21.8 g/m2) or normal aorta (96.04 ± 26.5 g/m2), with left ventricular hypertrophy (LVH) being twice as common in this group compared with the latter (60 vs. 28%, P < 0.0001). Conclusion: Prevalence of ascending aorta dilatation in hypertensive patients reaches 13%. Hypertensive individuals with enlarged ascending aorta showed significantly increased left ventricular mass, a well known sign of hypertension related cardiac damage and could thus represent a subset of hypertensive patients at an increased cardiovascular risk.

[1]  S. Laurent,et al.  Out of proportion proximal aortic remodeling: A subclinical marker of early vascular ageing? A systematic review. , 2016, International journal of cardiology.

[2]  M. Metra,et al.  Ascending Aortic Dimensions in Hypertensive Subjects: Reference Values for Two-Dimensional Echocardiography. , 2016, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[3]  F. Bamberg,et al.  Ascending aortic elongation and the risk of dissection. , 2016, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[4]  F. Asch,et al.  Normal Values and Differences in Ascending Aortic Diameter in a Healthy Population of Adults as Measured by the Pediatric versus Adult American Society of Echocardiography Guidelines. , 2016, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[5]  R. Devereux,et al.  Hemodynamic Correlates of Abnormal Aortic Root Dimension in an Adult Population: The Strong Heart Study , 2015, Journal of the American Heart Association.

[6]  J. Gottdiener,et al.  Recommendations on the use of echocardiography in adult hypertension: a report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE)†. , 2015, European heart journal cardiovascular Imaging.

[7]  V. Aboyans,et al.  [2014 ESC Guidelines on the diagnosis and treatment of aortic diseases]. , 2015, Kardiologia polska.

[8]  Rossella Fattori,et al.  Multimodality imaging of diseases of the thoracic aorta in adults: from the American Society of Echocardiography and the European Association of Cardiovascular Imaging: endorsed by the Society of Cardiovascular Computed Tomography and Society for Cardiovascular Magnetic Resonance. , 2015, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[9]  Victor Mor-Avi,et al.  Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. , 2015, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[10]  F. Veglio,et al.  Echocardiographic aortic root dilatation in hypertensive patients: a systematic review and meta-analysis , 2014, Journal of hypertension.

[11]  G. Mancia,et al.  Aortic root diameter and risk of cardiovascular events in a general population: data from the PAMELA study , 2014, Journal of hypertension.

[12]  L. Badano,et al.  Ascending aorta diameters measured by echocardiography using both leading edge-to-leading edge and inner edge-to-inner edge conventions in healthy volunteers. , 2014, European heart journal cardiovascular Imaging.

[13]  Jeroen J. Bax,et al.  2007 ESH-ESC Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). , 2007, Blood pressure.

[14]  C. Magnino,et al.  Ascending aortic dilatation, arterial stiffness and cardiac organ damage in essential hypertension , 2012, Journal of hypertension.

[15]  M. Salvetti,et al.  Aortic root dilatation in hypertensive patients: A multicenter survey in echocardiographic practice , 2011, Blood pressure.

[16]  David M. Williams,et al.  2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease. A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, Ame , 2010, Journal of the American College of Cardiology.

[17]  K. Eagle,et al.  Aortic Diameter ≥5.5 cm Is Not a Good Predictor of Type A Aortic Dissection: Observations From the International Registry of Acute Aortic Dissection (IRAD) , 2007, Circulation.

[18]  C. Nienaber,et al.  Etiology, pathogenesis and management of thoracic aortic aneurysm , 2007, Nature Clinical Practice Cardiovascular Medicine.

[19]  J. Gardin,et al.  Usefulness of aortic root dimension in persons > or = 65 years of age in predicting heart failure, stroke, cardiovascular mortality, all-cause mortality and acute myocardial infarction (from the Cardiovascular Health Study). , 2006, The American journal of cardiology.

[20]  K. Eagle,et al.  Aortic Dissection: New Frontiers in Diagnosis and Management: Part II: Therapeutic Management and Follow-Up , 2003, Circulation.