Key result
A purely aortic diameter-based assessment of thoracic aortic aneurysm risk is limited, as over 80% of ascending aorta dissections occur at a size lower than the recommended threshold of 55 mm.
Why the study?
Ascending thoracic aortic aneurysm epidemiology remains understudied and guideline-recommended purely diameter-based risk assessment fails to capture over 80% of dissections occurring below the 55 mm threshold.
Do imaging-based biomechanical assessments improve the prediction of dissection risk in patients with ascending thoracic aortic dilatation compared to purely diameter-based assessment?
Do imaging-based biomechanical assessments improve the prediction of dissection risk in patients with ascending thoracic aortic dilatation compared to purely diameter-based assessment?
Current diameter-based thresholds for ascending thoracic aortic aneurysm miss over 80% of dissections, emphasizing the need for personalized risk assessment integrating biomechanical imaging, genotypes, and phenotypes.
Guidelines endorse diameter-based assessment for ascending aortic aneurysms; leaves open whether refined risk models improve prediction.
Ascending thoracic aortic aneurysm is a life-threatening disease, which is difficult to detect prior to the occurrence of a catastrophe. Epidemiology patterns of ascending thoracic aortic dilations/aneurysms remain understudied, whereas the risk assessment of it may be improved. The electronic databases PubMed/Medline 1966-2022, Web of Science 1975-2022, Scopus 1975-2022, and RSCI 1994-2022 were searched. The current guidelines recommend a purely aortic diameter-based assessment of the thoracic aortic aneurysm risk, but over 80% of the ascending aorta dissections occur at a size that is lower than the recommended threshold of 55 mm. Moreover, a 55 mm diameter criterion could exclude a vast majority (up to 99%) of the patients from preventive surgery. The authors review several visualization-based and alternative approaches which are proposed to better predict the risk of dissection in patients with borderline dilated thoracic aorta. The imaging-based assessments of the biomechanical aortic properties, the Young's elastic modulus, the Windkessel function, compliance, distensibility, wall shear stress, pulse wave velocity, and some other parameters have been proposed to improve the risk assessment in patients with ascending thoracic aortic aneurysm. While the authors do not argue for shifting the diameter threshold to the left, they emphasize the need for more personalized solutions that integrate the imaging data with the patient's genotypes and phenotypes in this heterogeneous pathology.
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Anfinogenova et al. (2022) conducted a review in Ascending thoracic aortic dilatation/aneurysm. Imaging-based and alternative risk assessment approaches vs. Purely aortic diameter-based assessment was evaluated. A purely aortic diameter-based assessment of thoracic aortic aneurysm risk is limited, as over 80% of ascending aorta dissections occur at a size lower than the recommended threshold of 55 mm.
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