Qazi Saadia, Gona Philimon N, Musgrave Rebecca M, Fox Caroline S, Massaro Joseph M, Hoffmann Udo, Chuang Michael L, O'Donnell Christopher J
The National Heart, Lung and Blood Institute's (NHLBI) Framingham Heart Study, Framingham, MA.
Division of Cardiology, Brigham and Women's Hospital, Boston, MA.
Am Heart J Plus. 2023 Feb;26. doi: 10.1016/j.ahjo.2022.100247. Epub 2022 Dec 31.
Aortic arch geometry changes with age, including an increase in aortic arch width (AAW). High AAW is a predictor of incident adverse cardiovascular disease (CVD) events, but its distribution and determinants are unknown. We hypothesized that traditional CVD risk factors, in addition to age, are associated with increased AAW in community-dwelling adults.
Framingham Offspring and Third Generation cohort participants (N=3026, 52% Men) underwent thoracic multidetector computed tomography (MDCT). A referent group (733M, 738W) free of clinical CVD, hypertension, dyslipidemia, smoking, and diabetes was used to generate sex and 10-year age-group specific upper 90th percentile (P90) cut-points for AAW. AAW was measured as the distance between the cross-sectional centroids of the ascending and descending thoracic aorta. Multivariable logistic regression models were used to identify clinical correlates of high AAW (≥referent P90) in the overall study group.
Among referent participants, AAW increased with greater age-group, p for trend <0.0001 in each sex. Overall and within each age group, AAW was greater in men than women, p<0.0001 all comparisons. Across all participants, high AAW was associated with greater age (odds ratio, OR=1.34/10y; 95% confidence interval 1.20 - 1.50), body surface area (OR=1.97/SD; 1.62 - 2.40), diastolic blood pressure (OR=1.59/10mmHg; 1.40 - 1.81), pack-years smoked (OR=1.07; 1.02 - 1.13), and prevalent CVD (OR=1.64; 1.08 - 2.49).
AAW increases with greater age, body size, diastolic blood pressure and burden of smoking. High AAW (≥referent P90) is also associated with prevalent (clinically apparent) CVD. AAW is often seen on and easily measured from tomographic thoracic images and has prognostic value.
主动脉弓的几何形状随年龄变化，包括主动脉弓宽度（AAW）增加。高AAW是心血管疾病（CVD）不良事件发生的预测指标，但其分布和决定因素尚不清楚。我们假设，除年龄外，传统的CVD危险因素与社区居住成年人的AAW增加有关。
弗雷明汉后代和第三代队列参与者（N = 3026，52%为男性）接受了胸部多排螺旋计算机断层扫描（MDCT）。使用一个无临床CVD、高血压、血脂异常、吸烟和糖尿病的参照组（733名男性，738名女性）来生成按性别和10岁年龄组划分的AAW的第90百分位数（P90）切点。AAW测量为胸主动脉升部和降部横截面质心之间的距离。多变量逻辑回归模型用于确定整个研究组中高AAW（≥参照P90）的临床相关因素。
在参照参与者中，AAW随年龄组增加而增加，各性别趋势p<0.0001。总体而言，在每个年龄组内，男性的AAW均大于女性，所有比较p<0.0001。在所有参与者中，高AAW与年龄较大（比值比，OR = 1.34/10岁；95%置信区间1.20 - 1.50）、体表面积（OR = 1.97/标准差；1.62 - 2.40）、舒张压（OR = 1.59/10mmHg；1.40 - 1.81）、吸烟包年数（OR = 1.07；1.02 - 1.13）和现患CVD（OR = 1.64；1.08 - 2.49）相关。
AAW随年龄、体型、舒张压和吸烟负担增加而增加。高AAW（≥参照P９０）也与现患（临床显性）CVD相关。AAW常在胸部断层图像上可见且易于测量，具有预后价值。
