Key result
Decreased descending aortic distensibility fails to independently predict major cardiovascular events.
Why the study?
Aortic distensibility determines cardiovascular morbidity and mortality, but data on the association between descending thoracic aortic distensibility and cardiovascular outcomes are scant.
Does decreased descending aortic distensibility independently predict the composite of all-cause mortality, MI, stroke, or coronary revascularization in patients referred for CMR?
Cohort (n=928)
No
Does decreased descending aortic distensibility independently predict the composite of all-cause mortality, MI, stroke, or coronary revascularization in patients referred for CMR?
Although decreasing descending aortic distensibility correlates with adverse cardiovascular risk profiles in a real-world referral cohort, it does not act as an independent predictor of major cardiovascular events once adjusted for established risk factors.
Answers are grounded in this paper and cite their sources.
Aortic distensibility ≤ median should not yet inform independent risk stratification; leaves open its incremental value beyond traditional factors in CMR cohorts.
Background: Aortic distensibility (AD) is an important determinant of cardiovascular (CV) morbidity and mortality. There is scant data on the association between AD measured within the descending thoracic aorta and CV outcomes. Objective: We evaluated the association of AD at the descending thoracic aorta (AD desc ) with the primary outcome of all-cause mortality, myocardial infarction (MI), stroke or coronary revascularization in patients referred for a cardiovascular magnetic resonance (CMR) study. Methods: 928 consecutive patients [(mean age 60 ± 17; 33% with prior cardiovascular disease (CVD))] were evaluated. AD desc was measured at the cross-section of the descending thoracic aorta in the 4-chamber view (via steady-state free precession [SSFP] cine sequences) and was grouped into quintiles (with the 1st quintile corresponding to the least AD, i.e., the stiffest aorta). Cox proportional-hazards regression analysis were performed for the primary outcome. Results: A total of 315 patients (34%) experienced the primary outcome during a median (25% IQR, 75% IQR) follow-up of 5.0 (0.56, 9.3) years. A decreased AD was significantly associated with hypertension, diabetes, renal disease, and dyslipidemia (p < 0.0001). A primary outcome occurred in 43% of patients with AD desc ≤ median compared to 25% with AD desc > median, p < 0.0001, and in 44% of patients with AD desc in the 1st quintile compared to 31% with AD desc in the other quintiles (p = 0.0004). Event free survival was incrementally reduced amongst quintiles (p < 0.0001). However, AD desc ≤ median was not an independent predictor of the primary endpoint after multivariable adjustment in the overall population [adjusted HR 1.09 (95% CI:0.82– 1.45), p = 0.518] or in the subgroup analysis of patients with or without prior CVD. Conclusion: In this real-world cohort of 928 patients referred for CMR, AD desc is not an independent predictor of CV outcomes.
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Sood et al. (2022) conducted a cohort in Patients referred for cardiovascular magnetic resonance (CMR) imaging (n=928). Decreased descending aortic distensibility (AD desc ≤ median) vs. Higher descending aortic distensibility (AD desc > median) was evaluated on Composite of all-cause mortality, myocardial infarction (MI), stroke, or coronary revascularization (adjusted HR 1.09, 95% CI 0.82-1.45, p=0.518). Decreased descending aortic distensibility (≤ median) did not independently predict the primary composite cardiovascular outcome after multivariable adjustment (adjusted HR 1.09).
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