University of Chicago, Chicago, Illinois.
MedStar Health Research Institute, Washington, District of Columbia.
J Am Soc Echocardiogr. 2022 Mar;35(3):267-274. doi: 10.1016/j.echo.2021.09.011. Epub 2021 Oct 4.
Accurate measurements of the aortic annulus and root are important for guiding therapeutic decisions regarding the need for aortic surgery. Current echocardiographic guidelines for identification of aortic root dilatation are limited because current normative values were derived predominantly from white individuals in narrow age ranges, and based partially on M-mode measurements. Using data from the World Alliance Societies of Echocardiography study, the authors sought to establish normal ranges of aortic dimensions across sexes, races, and a wide range of ages.
Adult individuals free of heart, lung, and kidney disease were prospectively enrolled from 15 countries, with even distributions among sexes and age groups: young (18-40 years), middle aged (41-65 years) and old (>65 years). Transthoracic two-dimensional echocardiograms of 1,585 subjects (mean age, 47 ± 17 years; 50.4% men; mean body surface area [BSA], 1.77 ± 0.22 m) were analyzed in a core laboratory following American Society of Echocardiography guidelines. Measurements, indexed separately by BSA and by height, included the aortic annulus, sinuses of Valsalva, and sinotubular junction. Differences among age, sex, and racial groups were evaluated using unpaired two-tailed Student's t tests.
All aortic root dimensions were larger in men compared with women. After indexing to BSA, all measured dimensions were significantly larger in women, whereas men continued to show larger dimensions after indexing to height. Of note, the upper limits of normal for all aortic dimensions were lower across all age groups, compared with the guidelines. Aortic dimensions were larger in older age groups in both sexes, a trend that persisted regardless of BSA or height adjustment. Last, differences in aortic dimensions were also observed according to race: Asians had the smallest nonindexed aortic dimensions at all levels.
There are significant differences in aortic dimensions according to sex, age, and race. Thus, current guideline-recommended normal ranges may need to be adjusted to account for these differences.
准确测量主动脉瓣环和根部对于指导是否需要进行主动脉手术的治疗决策非常重要。目前，用于识别主动脉根部扩张的超声心动图指南存在局限性，因为当前的正常值主要来源于窄年龄段的白人个体，且部分基于 M 型测量。作者利用来自世界超声心动图联盟研究的数据，旨在建立跨性别、种族和广泛年龄范围的主动脉尺寸正常范围。
来自 15 个国家的无心脏、肺部和肾脏疾病的成年个体前瞻性地被纳入研究，其在性别和年龄组之间均匀分布：年轻组（18-40 岁）、中年组（41-65 岁）和老年组（>65 岁）。根据美国超声心动图学会的指南，在一个核心实验室对 1585 名受试者（平均年龄 47±17 岁；50.4%为男性；平均体表面积[BSA]为 1.77±0.22m）的经胸二维超声心动图进行分析。分别按 BSA 和身高进行指数化的测量包括主动脉瓣环、瓦尔萨尔瓦窦和窦管交界。使用未配对双尾学生 t 检验评估年龄、性别和种族组之间的差异。
与女性相比，所有主动脉根部尺寸在男性中均更大。按 BSA 指数化后，所有测量的尺寸在女性中均显著更大，而男性在按身高指数化后仍然显示出更大的尺寸。值得注意的是，与指南相比，所有主动脉尺寸的正常上限在所有年龄组中均较低。男女两性的年龄较大组的主动脉尺寸均较大，这一趋势在无论 BSA 或身高调整后都持续存在。最后，还根据种族观察到主动脉尺寸的差异：亚洲人的所有未指数化主动脉尺寸在各个水平都最小。
主动脉尺寸存在明显的性别、年龄和种族差异。因此，当前指南推荐的正常范围可能需要进行调整以考虑这些差异。
