Henry Matthew, Campello Jorge Carlos A, van Bakel Pieter A J, Knauer Heather A, MacEachern Mark, van Herwaarden Joost A, Teixidó-Tura Gisela, Evangelista Arturo, Jeremy Richmond W, Figueroa C A, Patel Himanshu J, Hofmann Bowman Marion, Eagle Kim, Burris Nicholas S
Department of Radiology University of Michigan Ann Arbor MI USA.
Department of Cardiac Surgery University of Michigan Ann Arbor MI USA.
J Am Heart Assoc. 2025 Apr;14(7):e038821. doi: 10.1161/JAHA.124.038821. Epub 2025 Mar 27.
Thoracic aortic aneurysm (TAA) is an indolent, potentially fatal disease, which progresses at variable rates that are influenced by pathogenesis and patient characteristics. We conducted a systematic review and meta-analysis to synthesize the current evidence on growth rate (GR) and predictive factors among patients with syndromic and nonsyndromic heritable thoracic aortic disease, bicuspid aortic valve, and sporadic TAA.
Online databases were searched for studies that reported aortic growth on adult patients with asymptomatic TAA. Pooled GRs were calculated for 3 different TAA groups: syndromic heritable thoracic aortic disease, bicuspid aortic valve, and sporadic TAA. The search yielded 6297 studies, of which 85 were included in the systematic review, and 55 in the meta-analysis of growth rate (10 syndromic heritable thoracic aortic disease, 31 bicuspid aortic valve, and 34 sporadic subgroups). Mean observed TAA GR was 0.25 mm/y (95% CI, -0.18 to 0.68) in Turner syndrome, 0.45 mm/y (95% CI, 0.00-0.90) in Marfan syndrome, and 0.81 mm/y (95% CI, -0.46 to 2.08) in Loeys-Dietz syndrome. The mean observed GR in patients with bicuspid aortic valve before aortic valve surgery was 0.37 mm/y (95% CI, 0.29-0.46), compared with 0.18 mm/y (95% CI, 0.14-0.33) in postsurgical studies. Mean observed GR in sporadic ascending TAA was 0.33 mm/y (95% CI, 0.13-0.52) and 2.71 mm/y (95% CI, 0.53-4.88) in descending TAA.
Considering all pathogeneses, ascending TAAs typically grow at 0.25 to 1 mm/y, and thus annual surveillance is likely too frequent to detect growth in most patients. Studies vary widely in populations, methodology, and outcomes, with few high-quality longitudinal studies and no predictors of aortic GR.
胸主动脉瘤（TAA）是一种进展缓慢但可能致命的疾病，其进展速度因发病机制和患者特征而异。我们进行了一项系统评价和荟萃分析，以综合目前关于综合征性和非综合征性遗传性胸主动脉疾病、二叶式主动脉瓣和散发性TAA患者的生长速率（GR）及预测因素的证据。
检索在线数据库，查找报告无症状TAA成年患者主动脉生长情况的研究。计算了3个不同TAA组的汇总GR：综合征性遗传性胸主动脉疾病、二叶式主动脉瓣和散发性TAA。检索共获得6297项研究，其中85项纳入系统评价，55项纳入生长速率的荟萃分析（10项综合征性遗传性胸主动脉疾病、31项二叶式主动脉瓣和34项散发性亚组）。特纳综合征患者中观察到的TAA平均GR为0.25毫米/年（95%CI，-0.18至0.68），马方综合征为0.45毫米/年（95%CI，0.00-0.90），洛伊斯-迪茨综合征为0.81毫米/年（95%CI，-0.46至2.08）。主动脉瓣手术前二叶式主动脉瓣患者观察到的平均GR为0.37毫米/年（95%CI，0.29-0.46），而术后研究中的为0.18毫米/年（95%CI，0.14-0.33）。散发性升主动脉TAA观察到的平均GR为0.33毫米/年（95%CI，0.13-0.52），降主动脉TAA为2.71毫米/年（95%CI，0.53-4.88）。
考虑到所有发病机制，升主动脉TAA通常以每年0.25至1毫米的速度生长，因此每年进行监测可能过于频繁，无法在大多数患者中检测到生长情况。各项研究在人群、方法和结果方面差异很大，高质量的纵向研究很少，且没有主动脉GR的预测指标。
