Introduction Aortic dilatation is a common finding in patients with aortic valve disease or genetic connective tissue disease, such as Marfan’s. It is known that dilatation of the aorta is a precursor for life threatening aortic aneurysm leading to rupture or dissection (1,2,3). The ESC recommends that in patients with Marfan’s syndrome, surgical intervention is offered once the aortic diameter is >50mm or >45mm if other risk factors are present, and in patients with bicuspid aortic valve, once the aortic diameter reaches >55mm or >50mm if other risk factors present (1). There is currently a lack of literature on the incidence of aortic dilatation in the general or even hospital population though there has been data suggesting an incidence of aortic aneurysm to be 5.9 cases per 100,000 (2). In patients with hypertension, the prevalence of aortic dilatation was reported to be as high as 12% (3). The aim of our project was investigate the incidence of aortic dilatation by echocardiography in our hospital population which may lay the foundation for population study.
Methods A randomised retrospective review was carried out using the electronic echocardiogram database at our hospital. Echocardiograms performed on every Thursday between 1st October 2016 and 1st April 2018 were included in this study. Aortic dilatation was defined if the aortic root was >3.8 cm, or ascending aorta>3.6 cm. Along with echocardiographic analyses, basic patient demographic variables including age and gender were recorded.
Results A total of 2150 echocardiograms were analysed over the 18 months. The median age of our cohort was 69 years (22 - 94). 66% of our patients were males and 34% females. 146 patients were found to have aortic dilatation. Therefore, the incidence of aortic dilatation was 6.8% in our study population.
Conclusion The incidence of aortic dilatation in our hospital population of 6.8% was significantly higher than we expected. It is a staggering 1000 fold increase when compared to current literature surrounding the incidence of aortic aneurysm which is the possible end point of aortic dilatation(1,2). Based on the incidence established in this study, our hospital alone would have at least 400 patients with a dilated aorta in a year. Due to the potential detrimental prognosis of aortic dilatation, further investigations are certainly warranted to identify risk factors related to the development and progression of aortic dilatation as well as the pattern of progression.
Authors/Task Force members, et al. ‘2014 ESC/EACTS guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI).’ European heart journal 35.37 (2014): 2541–2619.
Coady, Michael A., et al. ‘Natural history, pathogenesis, and etiology of thoracic aortic aneurysms and dissections.’ Cardiology clinics 17.4 (1999): 615–635.
Cuspidi, Cesare, et al. ‘Aortic root dilatation in hypertensive patients: a multicenter survey in echocardiographic practice.’ Blood pressure 20.5 (2011): 267–273.
Conflict of Interest Nil
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