Carrero María C, Matta Maria G, Constantin Iván, Masson Gerardo, Asch Federico M
Consejo de Ecocardiografía y Doppler vascular "Oscar Orías"- Sociedad Argentina de Cardiología, Buenos Aires, Argentina.
Department of Cardiology. Gold Coast University Hospital. Southport, Australia.
Arch Cardiol Mex. 2025 Feb 28;95(2):171-7. doi: 10.24875/ACM.24000185.
Patient body size and sex are significant factors in determining aortic dimensions. While females generally have smaller aortic dimensions, the criteria for surgical intervention in thoracic aortic aneurysms primarily rely on absolute diameters, disregarding sex-specific differences. The aim of this study was to compare sex differences in the upper limit of normal (ULN) and Z score in the population of a prospective nationwide multicenter registry and to determine the usefulness and fairness of guideline recommendations regarding aortic diameters in females.
Transthoracic echocardiograms were performed on all patients enrolled measuring aortic dimensions at six levels following the current standard recommendations. Absolute diameters and indexed diameters by body surface area (BSA) and height were compared between males and females.
A total of 1,000 healthy adults were included, with an average age of 38.3 ± 12.7 years. Among them, 553 were females, and the majority were either Caucasian or Native American. Females exhibited lower values in all anthropometric parameters, echocardiographic measurements, and blood pressure. Analysis of aortic measurements revealed that females had lower absolute aortic diameters across all segments. However, when indexed parameters were examined in the aortic root and Sino tubular Junction, females demonstrated lower height-indexed diameters but higher BSA-indexed diameters. The ULN for females, correlating with a Z-score of 2.5, was determined to be 3.62 cm.
Our study demonstrates the need for sex-specific considerations in defining aortic dilation, as females exhibit lower absolute aortic diameters but variations in indexed parameters, highlighting the limitations of using a universal cutoff value.
患者的体型和性别是决定主动脉尺寸的重要因素。虽然女性的主动脉尺寸通常较小，但胸主动脉瘤手术干预的标准主要依赖于绝对直径，而忽略了性别差异。本研究的目的是比较前瞻性全国多中心注册研究人群中正常上限（ULN）和Z评分的性别差异，并确定关于女性主动脉直径的指南建议的实用性和公平性。
按照当前标准建议，对所有入组患者进行经胸超声心动图检查，测量六个水平的主动脉尺寸。比较男性和女性之间的绝对直径以及按体表面积（BSA）和身高计算的指数直径。
共纳入1000名健康成年人，平均年龄为38.3±12.7岁。其中，女性553名，大多数为白种人或美洲原住民。女性在所有人体测量参数、超声心动图测量值和血压方面均表现出较低的值。主动脉测量分析显示，女性在所有节段的绝对主动脉直径均较低。然而，在检查主动脉根部和窦管交界处的指数参数时，女性的身高指数直径较低，但体表面积指数直径较高。女性的ULN与Z评分为2.5相关，确定为3.62 cm。
我们的研究表明，在定义主动脉扩张时需要考虑性别差异，因为女性的绝对主动脉直径较低，但指数参数存在差异，突出了使用通用临界值的局限性。
