Prevalence of aortic root dilatation and its association with valvular lesions: insights from 48,807 echocardiograms in the Z-TRACK Registry

Background Aortic root dilatation (ARD) is a clinically significant structural cardiac abnormality that may coexist with various valvular heart diseases. Characterizing its prevalence and relationship with specific valve lesions can enhance diagnostic accuracy and patient management. Purpose This study aimed to assess the prevalence of ARD, defined as an aortic root diameter greater than 40 mm, and to evaluate its association with mitral regurgitation (MR), mitral stenosis (MS), aortic regurgitation (AR), aortic stenosis (AS), and tricuspid regurgitation (TR) in a large single-center cohort. Methods A retrospective analysis was performed on 48,807 transthoracic echocardiograms collected in the Zabrze Transthoracic Registry for Advancing Cardiac Knowledge (Z-TRACK). Valvular lesions were categorized by severity (mild, moderate, severe). Multivariable linear regression was used to analyze the association between ARD and valvular lesions. Model fit and statistical significance of predictors were assessed. Results The regression model demonstrated modest but statistically significant explanatory power (R = 0.213, R² = 0.045, adjusted R² = 0.045, F(21, 48785) = 110.64, p < 0.0001). Moderate and severe mitral stenosis were significantly inversely associated with ARD (β = -0.0708, p = 0.015 and β = -0.0729, p = 0.032, respectively). Aortic regurgitation showed a strong positive association with ARD, especially at moderate and severe grades (β = 0.0312, p < 0.001 and β = 0.1921, p < 0.001), while mild aortic regurgitation was negatively associated (β = -0.0614, p < 0.001). Mitral regurgitation, tricuspid regurgitation, and aortic stenosis did not show statistically significant correlations with ARD. Conclusion In this large echocardiographic cohort, aortic root dilatation was significantly associated with the severity of aortic regurgitation and inversely related to mitral stenosis severity, whereas mitral regurgitation, tricuspid regurgitation, and aortic stenosis showed no significant associations. These findings underscore the complex interplay between valvular heart disease and aortic root dimensions and highlight the importance of comprehensive echocardiographic evaluation in patients with or at risk for ARD.