(Circulation. 1995;91:734-740.)
© 1995 American Heart Association, Inc.
Articles |
Determinants of Echocardiographic Aortic Root Size
The Framingham Heart Study
From the Framingham Heart Study, Framingham, Mass (R.S.V., M.G.L., D.L.); the Divisions of Cardiology and Clinical Epidemiology, Beth Israel Hospital, Boston, Mass (D.L.); Boston (Mass) University School of Medicine (R.S.V., M.G.L., D.L.); and the National Heart, Lung, and Blood Institute, Bethesda, Md (D.L.).
Background Previous studies that evaluated the determinants of aortic root size have not yielded uniform results. We examined the relations of age, height, weight, body surface area, sex, and blood pressure to echocardiographically determined aortic root size in a population-based cohort.
Methods and Results The study sample consisted of 1849 men and 2152 women in the Framingham Heart Study and Framingham Offspring Study who were free of clinically apparent cardiac disease when echocardiography was performed. Aortic root measurements were made by M-mode echocardiography using a leading-edge-to-leading-edge technique. The relations of age, height, weight, body surface area, and blood pressure variables (contemporary and those obtained 8 years before) to aortic root dimension were examined by use of sex-specific correlations and linear regression analyses. Age, height, weight, and sex emerged as the principal determinants of aortic root dimensions in adults (cumulative R2=.2085 in men and .2327 in women). The additional effect of contemporary or previous blood pressure measures was small and revealed direct associations of aortic root dimension with mean arterial and diastolic blood pressures and inverse associations with pulse and systolic blood pressures. Previous blood pressure measurements did not contribute significantly to prediction of aortic root size once contemporary blood pressure variables entered the models. Results of regression analyses using a sex-pooled data set showed that on average, the aortic root measurement in women was 2.4 mm smaller than that of men of comparable age, height, and weight. Logistic regression was used to assess the likelihood of aortic root enlargement according to blood pressure levels. After adjustment for age, height, and weight, the odds ratio of aortic dilation for a 1-SD increment in systolic pressure was 0.70 (95% CI, 0.52 to 0.95) in men and 0.79 (95% CI, 0.60 to 1.04) in women; the odds ratio for a 1-SD increment in diastolic pressure was 1.22 (95% CI, 0.91 to 1.63) in men and 1.33 (95% CI, 1.01 to 1.73) in women.
Conclusions Age, height, weight, and sex emerged as the principal determinants of aortic root dimensions. The additional influences of blood pressure measurements were small; direct associations of aortic root dimensions with mean arterial and diastolic blood pressures and inverse associations with pulse and systolic blood pressures were observed. Additional prospective studies are needed to confirm these observations and to assess the impact of aortic root dimensions on the incidence of hypertension.
Key Words: aorta • echocardiography • blood pressure
This article has been cited by other articles:
 |
|
 |
|
  J. R. Matos-Souza, M. E. Fernandes-Santos, E. L. Hoehne, K. G. Franchini, and W. Nadruz Jr Isolated mitral valve prolapse is an independent predictor of aortic root size in a general population Eur J Echocardiogr, December 17, 2009; (2009) jep219v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Hashimoto and S. Ito Some mechanical aspects of arterial aging: physiological overview based on pulse wave analysis Therapeutic Advances in Cardiovascular Disease, October 1, 2009; 3(5): 367 - 378. [Abstract] [PDF]
|
|
|
|
 |
|
 C. Meuleman, F. Boccara, S. Ederhy, G. Dufaitre, B. Fleury, and A. Cohen Is obstructive sleep apnea associated with greater thoracic aortic size? J. Am. Coll. Cardiol., March 3, 2009; 53(9): 815 - 815. [Full Text] [PDF]
|
|
|
|
 |
|
 T. M. Tadros, M. D. Klein, and O. M. Shapira Ascending Aortic Dilatation Associated With Bicuspid Aortic Valve: Pathophysiology, Molecular Biology, and Clinical Implications Circulation, February 17, 2009; 119(6): 880 - 890. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Sugawara, K. Hayashi, T. Yokoi, and H. Tanaka Age-associated elongation of the ascending aorta in adults. J. Am. Coll. Cardiol. Img., November 1, 2008; 1(6): 739 - 748. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Colao, M. Galderisi, A. Di Sarno, M. Pardo, M. Gaccione, M. D'Andrea, E. Guerra, R. Pivonello, G. Lerro, and G. Lombardi Increased Prevalence of Tricuspid Regurgitation in Patients with Prolactinomas Chronically Treated with Cabergoline J. Clin. Endocrinol. Metab., October 1, 2008; 93(10): 3777 - 3784. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. J.J. Aalberts, T. W. Waterbolk, J. P. van Tintelen, H. L. Hillege, P. W. Boonstra, and M. P. van den Berg Prophylactic aortic root surgery in patients with Marfan syndrome: 10 years' experience with a protocol based on body surface area Eur. J. Cardiothorac. Surg., September 1, 2008; 34(3): 589 - 594. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. D. Burman, J. Keegan, and P. J. Kilner Aortic Root Measurement by Cardiovascular Magnetic Resonance: Specification of Planes and Lines of Measurement and Corresponding Normal Values Circ Cardiovasc Imaging, September 1, 2008; 1(2): 104 - 113. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Ingelsson, M. J. Pencina, D. Levy, J. Aragam, G. F. Mitchell, E. J. Benjamin, and R. S. Vasan Aortic Root Diameter and Longitudinal Blood Pressure Tracking Hypertension, September 1, 2008; 52(3): 473 - 477. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. A van der Klaauw, J. J Bax, J. W A Smit, E. R Holman, V. Delgado, G. B Bleeker, N. R Biermasz, F. Roelfsema, J. A Romijn, and A. M Pereira Increased aortic root diameters in patients with acromegaly Eur. J. Endocrinol., August 1, 2008; 159(2): 97 - 103. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. M. Dart, B. A. Kingwell, C. D. Gatzka, K. Willson, Y.-L. Liang, K. L. Berry, L. M.H. Wing, C. M. Reid, P. Ryan, L. J. Beilin, et al. Smaller Aortic Dimensions Do Not Fully Account for the Greater Pulse Pressure in Elderly Female Hypertensives Hypertension, April 1, 2008; 51(4): 1129 - 1134. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. M. Farasat, C. H. Morrell, A. Scuteri, C.-T. Ting, F. C.P. Yin, H. A. Spurgeon, C.-H. Chen, E. G. Lakatta, and S. S. Najjar Pulse Pressure Is Inversely Related to Aortic Root Diameter Implications for the Pathogenesis of Systolic Hypertension Hypertension, February 1, 2008; 51(2): 196 - 202. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. S. Vasan Pathogenesis of Elevated Peripheral Pulse Pressure: Some Reflections and Thinking Forward Hypertension, January 1, 2008; 51(1): 33 - 36. [Full Text] [PDF]
|
|
|
|
|
|
G. F. Mitchell, P. R. Conlin, M. E. Dunlap, Y. Lacourciere, J. M. O. Arnold, R. I. Ogilvie, J. Neutel, J. L. Izzo Jr, and M. A. Pfeffer Aortic Diameter, Wall Stiffness, and Wave Reflection in Systolic Hypertension Hypertension, January 1, 2008; 51(1): 105 - 111. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Segers, E. R. Rietzschel, M. L. De Buyzere, S. J. Vermeersch, D. De Bacquer, L. M. Van Bortel, G. De Backer, T. C. Gillebert, P. R. Verdonck, and on behalf of the Asklepios investigators Noninvasive (Input) Impedance, Pulse Wave Velocity, and Wave Reflection in Healthy Middle-Aged Men and Women Hypertension, June 1, 2007; 49(6): 1248 - 1255. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. F. Mitchell, C.-Y. Guo, E. J. Benjamin, M. G. Larson, M. J. Keyes, J. A. Vita, R. S. Vasan, and D. Levy Cross-Sectional Correlates of Increased Aortic Stiffness in the Community: The Framingham Heart Study Circulation, May 22, 2007; 115(20): 2628 - 2636. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. G. Svensson, E. H. Blackstone, J. Feng, D. de Oliveira, A. M. Gillinov, M. Thamilarasan, R. A. Grimm, B. Griffin, D. Hammer, T. Williams, et al. Are Marfan Syndrome and Marfanoid Patients Distinguishable on Long-Term Follow-Up? Ann. Thorac. Surg., March 1, 2007; 83(3): 1067 - 1074. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. C.Y. Tang, M. A. Coady, C. Lovoulos, A. Dardik, M. Aslan, J. A. Elefteriades, and G. Tellides Hyperplastic Cellular Remodeling of the Media in Ascending Thoracic Aortic Aneurysms Circulation, August 23, 2005; 112(8): 1098 - 1105. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Bekeredjian and P. A. Grayburn Valvular Heart Disease: Aortic Regurgitation Circulation, July 5, 2005; 112(1): 125 - 134. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. F. O'Rourke and W. W. Nichols Aortic Diameter, Aortic Stiffness, and Wave Reflection Increase With Age and Isolated Systolic Hypertension Hypertension, April 1, 2005; 45(4): 652 - 658. [Full Text] [PDF]
|
|
|
|
|
|
C. J. Beller, M. R. Labrosse, M. J. Thubrikar, G. Szabo, F. Robicsek, and S. Hagl Increased aortic wall stress in aortic insufficiency: clinical data and computer model Eur. J. Cardiothorac. Surg., February 1, 2005; 27(2): 270 - 275. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Pico, J. Labreuche, A. Cohen, P.-J. Touboul, P. Amarenco, and for the GENIC investigators Intracranial arterial dolichoectasia is associated with enlarged descending thoracic aorta Neurology, December 14, 2004; 63(11): 2016 - 2021. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. J. Nollen, M. Groenink, J. G.P. Tijssen, E. E. van der Wall, and B. J.M. Mulder Aortic stiffness and diameter predict progressive aortic dilatation in patients with Marfan syndrome Eur. Heart J., July 1, 2004; 25(13): 1146 - 1152. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. F. O'Rourke, M. E. Safar, W. W. Nichols, G. F. Mitchell, J. L. Izzo Jr, Y. Lacourciere, J.-P. Ouellet, J. Neutel, L. J. Kerwin, A. J. Block, et al. Proximal Aortic Diameter and Aortic Pressure-Flow Relationship in Systolic Hypertension * Response Circulation, May 25, 2004; 109(20): e227 - e228. [Full Text] [PDF]
|
|
|
|
|
|
G. F. Mitchell, Y. Lacourciere, J.-P. Ouellet, J. L. Izzo Jr, J. Neutel, L. J. Kerwin, A. J. Block, and M. A. Pfeffer Determinants of Elevated Pulse Pressure in Middle-Aged and Older Subjects With Uncomplicated Systolic Hypertension: The Role of Proximal Aortic Diameter and the Aortic Pressure-Flow Relationship Circulation, September 30, 2003; 108(13): 1592 - 1598. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Agmon, B. K. Khandheria, I. Meissner, G. L. Schwartz, J. D. Sicks, A. J. Fought, W. M. O'Fallon, D. O. Wiebers, and A. J. Tajik Is aortic dilatation an atherosclerosis-related process?: Clinical, laboratory, and transesophageal echocardiographiccorrelates of thoracic aortic dimensions in the populationwith implications for thoracic aortic aneurysm formation J. Am. Coll. Cardiol., September 17, 2003; 42(6): 1076 - 1083. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. G. Svensson, K.-H. Kim, B. W. Lytle, and D. M. Cosgrove Relationship of aortic cross-sectional area to height ratio and the risk of aortic dissection in patients with bicuspid aortic valves J. Thorac. Cardiovasc. Surg., September 1, 2003; 126(3): 892 - 893. [Full Text] [PDF]
|
|
|
|
 |
|
 V. T. Nkomo, M. Enriquez-Sarano, N. M. Ammash, L. J. Melton III, K. R. Bailey, V. Desjardins, R. A. Horn, and A. J. Tajik Bicuspid Aortic Valve Associated With Aortic Dilatation: A Community-Based Study Arterioscler Thromb Vasc Biol, February 1, 2003; 23(2): 351 - 356. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Niwa, S. C. Siu, G. D. Webb, and M. A. Gatzoulis Progressive Aortic Root Dilatation in Adults Late After Repair of Tetralogy of Fallot Circulation, September 10, 2002; 106(11): 1374 - 1378. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. N. Bella, J. W. MacCluer, M. J. Roman, L. Almasy, K. E. North, T. K. Welty, E. T. Lee, R. R. Fabsitz, B. V. Howard, and R. B. Devereux Genetic Influences on Aortic Root Size in American Indians: The Strong Heart Study Arterioscler Thromb Vasc Biol, June 1, 2002; 22(6): 1008 - 1011. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. G. Svensson and L. Khitin Aortic cross-sectional area/height ratio timing of aortic surgery in asymptomatic patients with Marfan syndrome J. Thorac. Cardiovasc. Surg., February 1, 2002; 123(2): 360 - 361. [Full Text] [PDF]
|
|
|
|
|
|
V. Palmieri, J. N. Bella, D. K. Arnett, M. J. Roman, A. Oberman, D. W. Kitzman, P. N. Hopkins, M. Paranicas, D. C. Rao, and R. B. Devereux Aortic Root Dilatation at Sinuses of Valsalva and Aortic Regurgitation in Hypertensive and Normotensive Subjects : The Hypertension Genetic Epidemiology Network Study Hypertension, May 1, 2001; 37(5): 1229 - 1235. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. B. Capps, R. C. Elkins, and D. M. Fronk Body surface area as a predictor of aortic and pulmonary valve diameter J. Thorac. Cardiovasc. Surg., May 1, 2000; 119(5): 975 - 982. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Palmieri, G. de Simone, M. J. Roman, J. E. Schwartz, T. G. Pickering, and R. B. Devereux Ambulatory Blood Pressure and M;etabolic Abnormalities in Hypertensive Subjects With Inappropriately High Left Ventricular Mass Hypertension, November 1, 1999; 34(5): 1032 - 1040. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M Groenink, T A J Lohuis, J G P Tijssen, M S J Naeff, R C M Hennekam, E E van der Wall, and B J M Mulder Survival and complication free survival in Marfan's syndrome: implications of current guidelines Heart, October 1, 1999; 82(4): 499 - 504. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S Nistri, M D Sorbo, M Marin, M Palisi, R Scognamiglio, and G Thiene Aortic root dilatation in young men with normally functioning bicuspid aortic valves Heart, July 1, 1999; 82(1): 19 - 22. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Groenink, L Rozendaal, M S J Naeff, R C M Hennekam, A A M Hart, E E van der Wall, and B J M Mulder Marfan syndrome in children and adolescents: predictive and prognostic value of aortic root growth for screening for aortic complications Heart, August 1, 1998; 80(2): 163 - 169. [Abstract] [Full Text]
|
|
|
|
|
|
L. Rozendaal, M. Groenink, M. S J Naeff, R. C M Hennekam, A. A M Hart, E. E van der Wall, and B. J M Mulder Marfan syndrome in children and adolescents: an adjusted nomogram for screening aortic root dilatation Heart, January 1, 1998; 79(1): 69 - 72. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kim, M. J. Roman, M. C. Cavallini, J. E. Schwartz, T. G. Pickering, and R. B. Devereux Effect of Hypertension on Aortic Root Size and Prevalence of Aortic Regurgitation Hypertension, July 1, 1996; 28(1): 47 - 52. [Abstract] [Full Text]
|
|