Abstract FR475: Hypertension-associated Thoracic Aortic Aneurysms and Dilatations Have Minimal Annual Growth in the Setting of Intensive Risk Factor Management

Introduction: Thoracic aortic aneurysms and dilatations (TAA/Ds) may have a slower growth rate than previously thought. However, this is yet to be investigated in a cohort comprised exclusively of hypertension-associated TAA/Ds managed by a dedicated aortopathy service. Hypothesis: Hypertension-associated TAA/Ds have a slow annual growth rate with few associated deaths and aortic emergencies. Methods: We conducted a retrospective cohort study in consecutive individuals referred to a dedicated aortopathy service between 1st January 2015 and 31st December 2022 with both an enlarged thoracic aorta, defined as per the 2015 European Association of Cardiovascular Imaging guideline, and a hypertension diagnosis in the absence of other potential causes for aortic enlargement. Primary outcomes were average annual aorta diameter change between serial transthoracic echocardiography (TTE) imaging studies, non-elective (immediate or urgent) aortic root/ascending aorta surgery, and death related to aortic emergencies. Individuals who underwent ascending aorta/aortic root surgery prior to referral were excluded from analysis of non-elective aortic surgery and aortic growth rate. Aortic diameters were measured at the Sinus of Valsalva (SOV), sinotubular junction (STJ) and proximal ascending aorta (Asc) at end-diastole. The date of final censorship was 28th January 2024. Results: Of 221 individuals with hypertension-associated TAA/D, 148 (67%) were male with a median (Q1, Q3) age of 71 (63,77) (Table 1). Median (Q1, Q3) systolic and diastolic blood pressures at initial clinic appointment were 138 (127, 146) and 81 (70, 87) respectively. Amongst the 157 individuals with serial TTEs, the median annual aortic growth rate was zero at the SOV, STJ and Asc (Table 2) [mean (S.D) time between serial TTEs: 3.1 (2.1) years]. Amongst the 187 individuals without prior surgery to the aortic root/ascending aorta, there were seven (3.7%) elective surgeries and one (0.5%) urgent operation [mean (S.D) follow-up: 4.0 (2.2) years]. There were 19 (8.6%) deaths [mean (S.D) follow-up: 4.0 (2.3) years]. One death was associated to TAA/D in an individual with mycotic aneurysm (Figure 1). Conclusion: With intensive risk factor management, hypertension-associated TAA/Ds can be monitored with TTE and are associated with little short-term progression with few aortic emergencies. These data suggest that deferral of subsequent imaging may be acceptable for individuals without progression on serial TTEs.