Swahn Eva, Lekedal Hanna, Engvall Jan, Nyström Fredrik H, Jonasson Lena
Department of Cardiology, Linköping University Hospital, Linköping, Sweden.
Department of Health, Medicine and Caring Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden.
Eur Heart J Open. 2023 Aug 25;3(5):oead085. doi: 10.1093/ehjopen/oead085. eCollection 2023 Sep.
Dilation of the ascending aorta (AA) is often asymptomatic until a life-threatening dissection or rupture occurs. An overall increase in the use of thoracic imaging has enabled early and sometimes incidental identification of AA dilation. Still, the prevalence and determinants of AA dilation remain to be clarified. The aim was to identify and characterize persons with AA dilation in a middle-aged Swedish population.
We used the Swedish CardioPulmonary BioImage Study Linköping ( = 5058, age 50-65 years) to identify cases with AA diameter ≥ 40 mm on coronary computed tomography angiography (CCTA) or chest computed tomography. Age- and gender-matched individuals with AA diameter < 40 mm served as controls. Echocardiography, blood pressure (BP) measurements (office and home), pulse wave velocity (PWV), coronary artery calcification (CAC), CCTA-detected coronary atherosclerosis, and carotid ultrasound were used to characterize these subjects. We identified 70 cases (mean AA diameter 44 mm, 77% men) and matched these to 146 controls (mean AA diameter 34 mm). Bicuspid aortic valve and aortic valve dysfunction were more common in cases than in controls (8% vs. 0% and 39% vs. 11%, respectively). Both office and home BP levels were significantly higher among cases. Also, high PWV (>10 m/s) levels were more common in cases (33% vs. 17%). Neither CAC scores nor prevalence or burden of atherosclerosis in coronary and carotid arteries differed between groups.
The prevalence of dilated AA was 1.4% and showed positive associations with male gender, aortic valve pathology, and diastolic BP, though not with subclinical atherosclerosis.
升主动脉（AA）扩张通常无症状，直至发生危及生命的夹层或破裂。胸部影像学检查的广泛应用使得能够早期甚至偶然发现AA扩张。然而，AA扩张的患病率和决定因素仍有待明确。本研究旨在识别并描述瑞典中年人群中AA扩张患者的特征。
我们利用瑞典林雪平心肺生物图像研究（n = 5058，年龄50 - 65岁），通过冠状动脉计算机断层扫描血管造影（CCTA）或胸部计算机断层扫描识别升主动脉直径≥40 mm的病例。升主动脉直径<40 mm的年龄和性别匹配个体作为对照。采用超声心动图、血压测量（诊室和家庭）、脉搏波速度（PWV）、冠状动脉钙化（CAC）、CCTA检测的冠状动脉粥样硬化以及颈动脉超声对这些受试者进行特征描述。我们识别出70例病例（升主动脉平均直径44 mm，77%为男性），并将其与146例对照（升主动脉平均直径34 mm）进行匹配。病例组中二尖瓣主动脉瓣和主动脉瓣功能障碍比对照组更常见（分别为8%对0%和39%对11%）。病例组的诊室和家庭血压水平均显著更高。此外，病例组中高PWV（>10 m/s）水平更常见（33%对17%）。两组之间的CAC评分以及冠状动脉和颈动脉粥样硬化的患病率或负担均无差异。
扩张性AA的患病率为1.4%，与男性性别、主动脉瓣病变和舒张压呈正相关，但与亚临床动脉粥样硬化无关。
