<div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" paraid="2094033470" paraeid="{457821ba-ef4f-4dc2-97d1-38abb37e2042}{8}"><span class="NormalTextRun SCXW132017943 BCX0">Indexing<span> </span></span><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0">ascending<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW132017943 BCX0">aortopathy</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>(AA</span><span class="NormalTextRun SCXW132017943 BCX0">)<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">dimensions<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">to height instead of absolute diameters better<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">identifies</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>high-risk patients who fall below surgical criteria<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">—</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>particularly women</span><span> </span><span class="NormalTextRun SCXW132017943 BCX0">—</span><span class="NormalTextRun SCXW132017943 BCX0">researchers<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">i</span><span class="NormalTextRun SCXW132017943 BCX0">n a new large observational study<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">suggest.</span></span><span class="EOP Selected SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" paraid="1140630225" paraeid="{457821ba-ef4f-4dc2-97d1-38abb37e2042}{10}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0">The findings were published<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">Tuesday</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>online ahead of print in the<span> </span></span></span><em><span class="NormalTextRun SCXW132017943 BCX0">JACC: Advances</span></em><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0">, led by<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">Milind Y. Desai, MD,</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>and<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">Mohammed Abusafia, MD,</span><span> </span><span class="NormalTextRun SCXW132017943 BCX0">from the<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">Aortic<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW132017943 BCX0">Center</span><span class="NormalTextRun SCXW132017943 BCX0">, Cleveland Clinic.</span></span><span class="EOP Selected SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" paraid="766973787" paraeid="{457821ba-ef4f-4dc2-97d1-38abb37e2042}{12}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0">A largely asymptomatic</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>condition, AA often presents with serious, potentially fatal complications<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">—</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>including aortic dissection,<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">rupture</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>and death<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">—</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>after a typically benign course, the researchers noted. </span></span><span class="EOP Selected SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" paraid="598046351" paraeid="{457821ba-ef4f-4dc2-97d1-38abb37e2042}{14}"><span class="NormalTextRun SCXW132017943 BCX0">Diagnosis is often incidental during other screening or pre-emptive due to family history, while management typically involves “watchful waiting” and control of cardiovascular comorbidities until aortic dimensions reach a surgical threshold of 5.5cm, allowing for guideline-directed prophylactic aortic replacement. In certain cases, where AA occurs alongside severe aortic valvular disease, prophylactic aortic surgery is recommended at a lower 4.5cm threshold. </span><span class="EOP Selected SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" paraid="2126444550" paraeid="{457821ba-ef4f-4dc2-97d1-38abb37e2042}{16}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0">“</span><span class="NormalTextRun SCXW132017943 BCX0">However, societal guideline thresholds for surgical intervention have varied over time and continue to evolve with suggestion that indexing might be preferred in many cases over absolute diameters</span><span class="NormalTextRun SCXW132017943 BCX0">,” the researchers said</span><span class="NormalTextRun SCXW132017943 BCX0">. </span></span><span class="EOP Selected SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" paraid="1294661553" paraeid="{457821ba-ef4f-4dc2-97d1-38abb37e2042}{18}"><span class="NormalTextRun SCXW132017943 BCX0">These include widescale American<span> </span></span><a class="Hyperlink SCXW132017943 BCX0" href="https://www.ahajournals.org/doi/10.1161/CIR.0b013e3181d4739e" target="_blank" rel="noreferrer noopener"><span class="NormalTextRun SCXW132017943 BCX0" data-ccp-charstyle="Hyperlink">guidance</span></a><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>from 2010, European Society for Cardiology<span> </span></span><a class="Hyperlink SCXW132017943 BCX0" href="https://pubmed.ncbi.nlm.nih.gov/25173340/%5d" target="_blank" rel="noreferrer noopener"><span class="NormalTextRun SCXW132017943 BCX0" data-ccp-charstyle="Hyperlink">guidelines</span></a><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>from 2014 and American College of Cardiology/ American Heart Association<span> </span></span><a class="Hyperlink SCXW132017943 BCX0" href="https://linkinghub.elsevier.com/retrieve/pii/S0735109722057692" target="_blank" rel="noreferrer noopener"><span class="NormalTextRun SCXW132017943 BCX0" data-ccp-charstyle="Hyperlink">guidance</span></a><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>from 2022 and is</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>supported by<span> </span></span></span><a class="Hyperlink SCXW132017943 BCX0" href="https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.107.702720" target="_blank" rel="noreferrer noopener"><span class="NormalTextRun SCXW132017943 BCX0" data-ccp-charstyle="Hyperlink">observations</span></a><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>from the<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">International Registry of Acute Aortic Dissection</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>showing that 4 in 10 dissections occur below 5cm in any case</span><span class="NormalTextRun SCXW132017943 BCX0">, the researcher</span><span class="NormalTextRun SCXW132017943 BCX0">s</span><span> </span><span class="NormalTextRun SCXW132017943 BCX0">noted</span><span class="NormalTextRun SCXW132017943 BCX0">.</span></span><span class="EOP Selected SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" paraid="1935725629" paraeid="{457821ba-ef4f-4dc2-97d1-38abb37e2042}{20}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0">The</span><span class="NormalTextRun SCXW132017943 BCX0">y</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>also<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">highlighted</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>that thresholds for height-indexed metrics, such as the aortic height index (AHI) and cross-sectional area to height (CSAH) index have “shown value” in<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">identifying</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>at-risk patients below treatment guidelines.<span> </span></span></span><span class="EOP Selected SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" paraid="1602002320" paraeid="{457821ba-ef4f-4dc2-97d1-38abb37e2042}{22}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0">The current study enrolled a real-world population of<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">11,803</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>AA patients who did not meet current primary guideline criteria for prophylactic AA surgery</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>(aortic dimensions of 4 to 5 cm) as diagnosed on echocardiography between 2010 to 2023. The goal was to evaluate whether indexing aortic dimensions to height was associated with improved long-term risk stratification.</span></span><span class="EOP Selected SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" paraid="794168990" paraeid="{457821ba-ef4f-4dc2-97d1-38abb37e2042}{24}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0">Patients’<span> </span></span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW132017943 BCX0">b</span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW132017943 BCX0">aseline</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>mean age was 68 years (</span><span class="NormalTextRun SCXW132017943 BCX0">± 13</span><span class="NormalTextRun SCXW132017943 BCX0">), 79% were men and 28% had bicuspid aortic valve. A total 2,196 received aortic surgery vs 8,887 who were unoperated.<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">The a</span><span class="NormalTextRun SCXW132017943 BCX0">scending aorta was 4cm to 4.4cm for 58.3% of the unoperated group but none of the operated<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">group and</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>4.5cm to 4.9cm for 41.7% vs 100%, respectively (P<0.001).</span></span><span class="EOP Selected SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" paraid="231774698" paraeid="{457821ba-ef4f-4dc2-97d1-38abb37e2042}{26}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0">The mean ascending aortic diameter to height index was 2.51cm/m in the unoperated cohort vs 2.6 cm/m in the operated group (P<0.001).</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>This was stratified into 3 groups<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">—</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>those with mean ascending aortic diameter to height index’s less than 2.34 cm/m (38.7% of unoperated group vs 25% of operated), between 2.43cm/m to 3.20cm/m (61.1% vs 74.8%, respectively) and those with 3.21cm/m or above (0/2% vs 0.4%).</span></span><span class="EOP Selected SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" paraid="1446442709" paraeid="{457821ba-ef4f-4dc2-97d1-38abb37e2042}{28}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0">The mean AA diameter, AHI, and CSAH were 4.4 ± 0.2 cm, 2.53 ± 0.3 cm/m, and 8.8 ± 1 cm2 /m,<span> </span></span><span class="NormalTextRun SpellingErrorV2Themed SCXW132017943 BCX0">respectively</span><span class="NormalTextRun SpellingErrorV2Themed SCXW132017943 BCX0">.</span><span class="NormalTextRun SpellingErrorV2Themed SCXW132017943 BCX0">At</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>a mean follow-up of 6 years (</span><span class="NormalTextRun SCXW132017943 BCX0">± 4</span><span class="NormalTextRun SCXW132017943 BCX0">), the primary mortality outcome occurred for 84 (8.3%) of the operated group versus 1,058 (11.9%) of the unoperated cohort<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">(log-rank P value between operated and unoperated groups <0.001).</span></span><span class="EOP SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" paraid="321892282" paraeid="{457821ba-ef4f-4dc2-97d1-38abb37e2042}{34}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0">In the unoperated group there were</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>128 aortic dissections (1.4%) and 4 aortic ruptures (0.04%).</span></span><span class="EOP Selected SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" paraid="269549121" paraeid="{457821ba-ef4f-4dc2-97d1-38abb37e2042}{36}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0">In statistical modelling d</span><span class="NormalTextRun SCXW132017943 BCX0">ividing the unoperated sample into a derivation</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>(training set)</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>cohort (n = 3,887), spline analysis<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">demonstrated</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>an increase in hazard for death in women with AA diameter<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">≥</span><span class="NormalTextRun SCXW132017943 BCX0">4.5 cm and in all patients with AHI<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">≥</span><span class="NormalTextRun SCXW132017943 BCX0">2.5 cm/m or CSAH<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">≥</span><span class="NormalTextRun SCXW132017943 BCX0">9 cm</span></span><span class="NormalTextRun Superscript SCXW132017943 BCX0" data-fontsize="11">2<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">/m. </span><span class="EOP Selected SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" paraid="466670779" paraeid="{457821ba-ef4f-4dc2-97d1-38abb37e2042}{38}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0">Validation in a separate cohort (n = 5,000</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>separated from the<span> </span></span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW132017943 BCX0">3,887 derivation</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>cohort</span><span class="NormalTextRun SCXW132017943 BCX0">) confirmed that AHI<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">≥</span><span class="NormalTextRun SCXW132017943 BCX0">2.5 cm/m and CSAH<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">≥</span><span class="NormalTextRun SCXW132017943 BCX0">9 cm</span></span><span class="NormalTextRun Superscript SCXW132017943 BCX0" data-fontsize="11">2</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>/m were associated with higher long-term mortality (both P<0.05)</span><span class="EOP Selected SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" paraid="1348419257" paraeid="{457821ba-ef4f-4dc2-97d1-38abb37e2042}{40}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0">“</span><span class="NormalTextRun SCXW132017943 BCX0">Indexing AA dimensions to height better identifies high-risk AA patients, particularly women, who fall below surgical criteria</span><span class="NormalTextRun SCXW132017943 BCX0">,” the researchers concluded</span><span class="NormalTextRun SCXW132017943 BCX0">. </span></span><span class="EOP Selected SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" paraid="236131794" paraeid="{457821ba-ef4f-4dc2-97d1-38abb37e2042}{42}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0">“</span><span class="NormalTextRun SCXW132017943 BCX0">Further studies are needed to determine if this cohort may benefit from earlier intervention at lower size thresholds.</span><span class="NormalTextRun SCXW132017943 BCX0">”</span></span><span class="EOP Selected SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" paraid="2134088741" paraeid="{457821ba-ef4f-4dc2-97d1-38abb37e2042}{44}"><strong><span class="NormalTextRun SCXW132017943 BCX0">Sources:</span></strong><span class="EOP Selected SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" paraid="2046438925" paraeid="{457821ba-ef4f-4dc2-97d1-38abb37e2042}{47}"><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0">Desai M,<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">Abusafia</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>M, Jadam S, et a</span><span class="NormalTextRun SCXW132017943 BCX0">l.<span> </span></span><span class="NormalTextRun SCXW132017943 BCX0">Reappraisal of Surgical Threshold in Patients<span> </span></span><span class="NormalTextRun ContextualSpellingAndGrammarErrorV2Themed SCXW132017943 BCX0">With</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>Ascending Aortic Dilation</span><span class="NormalTextRun SCXW132017943 BCX0">:</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>Moving Beyond Aortic Diameters?</span><span> </span></span><em><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0">JACC: </span><span class="NormalTextRun SpellingErrorV2Themed SCXW132017943 BCX0">Adv.</span></span></em><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>2026</span><span class="NormalTextRun SCXW132017943 BCX0"><span> </span>July</span><span class="NormalTextRun SCXW132017943 BCX0">; 5:8.</span></span><span class="EOP Selected SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div> <div class="OutlineElement Ltr SCXW132017943 BCX0"> <p class="Paragraph SCXW132017943 BCX0" lang="EN-US" paraid="1713933521" paraeid="{2b9ef86a-3ee3-4ffd-bf2c-3fb7f671a434}{48}"><strong><span data-contrast="auto" xml:lang="EN-GB" lang="EN-GB" class="TextRun MacChromeBold SCXW132017943 BCX0"><span class="NormalTextRun SCXW132017943 BCX0">Image Credit: </span><span class="NormalTextRun SpellingErrorV2Themed SCXW132017943 BCX0">Kadmy</span><span class="NormalTextRun SCXW132017943 BCX0"> – stock.adobe.com</span></span></strong><span class="EOP Selected SCXW132017943 BCX0" data-ccp-props="{}"> </span></p> </div>