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. 2022 Mar;35(3):267-274.
doi: 10.1016/j.echo.2021.09.011. Epub 2021 Oct 4.

Normal Values of Aortic Root Size According to Age, Sex, and Race: Results of the World Alliance of Societies of Echocardiography Study

Hena N Patel  1 , Tatsuya Miyoshi  2 , Karima Addetia  1 , Rodolfo Citro  3 , Masao Daimon  4 , Pedro Gutierrez Fajardo  5 , Ravi R Kasliwal  6 , James N Kirkpatrick  7 , Mark J Monaghan  8 , Denisa Muraru  9 , Kofo O Ogunyankin  10 , Seung Woo Park  11 , Ricardo E Ronderos  12 , Anita Sadeghpour  13 , Gregory M Scalia  14 , Masaaki Takeuchi  15 , Wendy Tsang  16 , Edwin S Tucay  17 , Ana Clara Tude Rodrigues  18 , Vivekanandan Amuthan  19 , Yun Zhang  20 , Marcus Schreckenberg  21 , Michael Blankenhagen  21 , Markus Degel  21 , Niklas Hitschrich  21 , Victor Mor-Avi  1 , Federico M Asch  2 , Roberto M Lang  22 ; WASE Investigators
Affiliations

Normal Values of Aortic Root Size According to Age, Sex, and Race: Results of the World Alliance of Societies of Echocardiography Study

Hena N Patel et al. J Am Soc Echocardiogr. 2022 Mar.

Erratum in

  • Correction.
    [No authors listed] [No authors listed] J Am Soc Echocardiogr. 2023 Oct;36(10):1126. doi: 10.1016/j.echo.2023.07.009. Epub 2023 Aug 4. J Am Soc Echocardiogr. 2023. PMID: 37542502 No abstract available.

Abstract

Background: Accurate measurements of the aortic annulus and root are important for guiding therapeutic decisions regarding the need for aortic surgery. Current echocardiographic guidelines for identification of aortic root dilatation are limited because current normative values were derived predominantly from white individuals in narrow age ranges, and based partially on M-mode measurements. Using data from the World Alliance Societies of Echocardiography study, the authors sought to establish normal ranges of aortic dimensions across sexes, races, and a wide range of ages.

Methods: Adult individuals free of heart, lung, and kidney disease were prospectively enrolled from 15 countries, with even distributions among sexes and age groups: young (18-40 years), middle aged (41-65 years) and old (>65 years). Transthoracic two-dimensional echocardiograms of 1,585 subjects (mean age, 47 ± 17 years; 50.4% men; mean body surface area [BSA], 1.77 ± 0.22 m2) were analyzed in a core laboratory following American Society of Echocardiography guidelines. Measurements, indexed separately by BSA and by height, included the aortic annulus, sinuses of Valsalva, and sinotubular junction. Differences among age, sex, and racial groups were evaluated using unpaired two-tailed Student's t tests.

Results: All aortic root dimensions were larger in men compared with women. After indexing to BSA, all measured dimensions were significantly larger in women, whereas men continued to show larger dimensions after indexing to height. Of note, the upper limits of normal for all aortic dimensions were lower across all age groups, compared with the guidelines. Aortic dimensions were larger in older age groups in both sexes, a trend that persisted regardless of BSA or height adjustment. Last, differences in aortic dimensions were also observed according to race: Asians had the smallest nonindexed aortic dimensions at all levels.

Conclusions: There are significant differences in aortic dimensions according to sex, age, and race. Thus, current guideline-recommended normal ranges may need to be adjusted to account for these differences.

Keywords: 2D echocardiography; Aorta; Aortic root dimensions.

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Figures

Figure 1.
Figure 1.
Example of 2D echocardiographic measurements of aortic dimensions at the level of the aortic annulus (A), sinuses of Valsalva (B) and sinotubular junction (C). All measurements were obtained in a zoomed parasternal long-axis view. The aortic annulus was measured at mid-systole using the inner edge to inner edge method. The sinuses of Valsalva and sinotubular junction were measured at end-diastole using leading edge to leading edge technique.
Figure 2.
Figure 2.
Nomograms of aortic dimensions at the SoV level according to different calculated BSA, for three age groups. Dashed lines show existing guideline data ; colored area represents the upper and lower limits of normal, with the equation for the former (ULN) shown below each plot.
Figure 3.
Figure 3.
Nomograms of aortic dimensions at the SoV level according to different heights for three age groups. Colored area represents upper and lower limits of normal, with the equation for the former (ULN) shown below each plot.
See this image and copyright information in PMC

Comment in

  • Normal Aortic Dimensions: From A-to-Z Score.
    Wong C, Aurigemma GP, Parker MW. Wong C, et al. J Am Soc Echocardiogr. 2022 Mar;35(3):275-277. doi: 10.1016/j.echo.2021.12.001. Epub 2021 Dec 14. J Am Soc Echocardiogr. 2022. PMID: 34915135 No abstract available.

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