The Nonsyndromic Ascending Thoracic Aorta in a Population-Based Setting: A Five-Year Prospective Cohort Study (JACC February 2025-2)-Article: The Nonsyndromic Ascending Thoracic Aorta in a Population-Based Setting: A Five-Year Prospective Cohort Study

Article: The Nonsyndromic Ascending Thoracic Aorta in a Population-Based Setting: A Five-Year Prospective Cohort Study

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The study highlighted insights into the growth rates and risk factors associated with nonsyndromic ascending thoracic aortic aneurysms in a specific elderly population. This research encompassed a cohort from the DANCAVAS trials, examining over 78,000 participants aged 60-74 years via comprehensive cardiovascular assessments, primarily utilizing ECG-gated CT scans.<br /><br />Key findings revealed that the growth of the ascending aorta among predominantly male participants was slow, with an average increase of approximately 0.1 mm per year. Notably, 3.2% of men progressed from diameters of 45.0-49.9 mm to 50.0 mm over approximately five years. This slow progression rate calls into question the necessity of the currently recommended bi-annual surveillance scans for most asymptomatic patients, advocating potentially for longer intervals between observations.<br /><br />Additionally, 95% of those who suffered adverse aortic events (AAEs) had pre-event diameters at the surgical threshold of 50.0 mm, emphasizing that aortic diameter alone may not suffice for surgical timing decisions. A family history of aortic aneurysms was identified as a significant risk factor, with affected individuals bearing a markedly higher incidence rate of AAEs, advocating for genetic evaluations in such scenarios.<br /><br />The study also pointed to a need for further prospective research involving women, as the included female cohort was less substantial, limiting definitive conclusions about their risk profiles and growth patterns. Ultimately, these findings underscore the importance of individualized treatments and further exploration into genetic factors to optimize patient outcomes and more accurately determine surgical intervention thresholds.

Keywords

nonsyndromic ascending thoracic aortic aneurysms

elderly population

DANCAVAS trials

cardiovascular assessments

ECG-gated CT scans

aortic growth rates

risk factors

adverse aortic events

family history

genetic evaluations