Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Feb 28;95(2):171-177.
doi: 10.24875/ACM.24000185. Online ahead of print.

Sex-specific considerations in defining aortic dilation: findings from the MATEAR study

María C Carrero  1 , Maria G Matta  2 , Iván Constantin  1 , Gerardo Masson  3 , Federico M Asch  4
Affiliations

Sex-specific considerations in defining aortic dilation: findings from the MATEAR study

María C Carrero et al. Arch Cardiol Mex. .

Abstract
in English, Spanish

Objectives: Patient body size and sex are significant factors in determining aortic dimensions. While females generally have smaller aortic dimensions, the criteria for surgical intervention in thoracic aortic aneurysms primarily rely on absolute diameters, disregarding sex-specific differences. The aim of this study was to compare sex differences in the upper limit of normal (ULN) and Z score in the population of a prospective nationwide multicenter registry and to determine the usefulness and fairness of guideline recommendations regarding aortic diameters in females.

Materials and methods: Transthoracic echocardiograms were performed on all patients enrolled measuring aortic dimensions at six levels following the current standard recommendations. Absolute diameters and indexed diameters by body surface area (BSA) and height were compared between males and females.

Results: A total of 1,000 healthy adults were included, with an average age of 38.3 ± 12.7 years. Among them, 553 were females, and the majority were either Caucasian or Native American. Females exhibited lower values in all anthropometric parameters, echocardiographic measurements, and blood pressure. Analysis of aortic measurements revealed that females had lower absolute aortic diameters across all segments. However, when indexed parameters were examined in the aortic root and Sino tubular Junction, females demonstrated lower height-indexed diameters but higher BSA-indexed diameters. The ULN for females, correlating with a Z-score of 2.5, was determined to be 3.62 cm.

Conclusion: Our study demonstrates the need for sex-specific considerations in defining aortic dilation, as females exhibit lower absolute aortic diameters but variations in indexed parameters, highlighting the limitations of using a universal cutoff value.

Objetivo: Evaluar las diferencias de sexo en el límite superior de lo normal (ULN) y el puntaje Z de las dimensiones aórticas en una población de un registro multicéntrico nacional prospectivo, así como determinar la utilidad de las guías sobre los diámetros aórticos en mujeres.

Métodos: Se realizaron ecocardiogramas transtorácicos en todos los pacientes enrolados, midiendo las dimensiones aórticas en seis niveles siguiendo las recomendaciones estándar actuales. Se compararon los diámetros absolutos y los diámetros indexados por área de superficie corporal (BSA) y altura entre hombres y mujeres.

Resultados: Se incluyeron un total de 1,000 adultos sanos, con una edad promedio de 38.3 ± 12.7 años. De ellos, 553 eran mujeres, y la mayoría eran de origen caucásico o nativo americano. Las mujeres mostraron valores más bajos en todos los parámetros antropométricos, mediciones ecocardiográficas y presión arterial. El análisis de las mediciones aórticas reveló que las mujeres tenían diámetros aórticos absolutos más bajos en todos los segmentos. Sin embargo, cuando se examinaron los parámetros indexados en la raíz aórtica y la unión sino-tubular, las mujeres demostraron diámetros indexados por altura más bajos, pero diámetros indexados por BSA más altos. El ULN para las mujeres, correlacionado con un puntaje Z de 2.5, fue de 3.62 cm.

Conclusiones: Nuestro estudio demuestra la necesidad de considerar las diferencias de sexo al definir la dilatación aórtica, ya que las mujeres exhiben diámetros aórticos absolutos más bajos, pero variaciones en los parámetros indexados, lo que resalta las limitaciones de utilizar un valor de corte universal.

Keywords: Ascending aorta. Echocardiography. Female. Dimension. Reference values..

PubMed Disclaimer

Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Measurements of the aorta. From left to right: the annulus was measured at mid-systole (inner-to-inner edge, depicted in yellow), Sinuses of Valsalva, sinotubular junction, and ascending aorta were measured at end-diastole (leading-to-leading edge).
Figure 2
Figure 2
Comparison of absolute aortic diameters between males and females. The box plot displays the mean along with the 2.5th and 97.5th percentiles (p2.5 and p97.5, respectively). An asterisk (*) indicates significance at p < 0.0001.
See this image and copyright information in PMC

References

    1. Roman MJ, Devereux RB, Kramer-Fox R, O'Loughlin J. Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol. 1989;64:507–12. - PubMed
    1. Saura D, Dulgheru R, Caballero L, Bernard A, Kou S, Gonjilashvili N, et al. Two-dimensional transthoracic echocardiographic normal reference ranges for proximal aorta dimensions:results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging. 2017;18:167–79. - PubMed
    1. Campens L, Demulier L, De Groote K, Vandekerckhove K, De Wolf D, Roman MJ, et al. Reference values for echocardiographic assessment of the diameter of the aortic root and ascending aorta spanning all age categories. Am J Cardiol. 2014;114:914–20. - PubMed
    1. Devereux RB, de Simone G, Arnett DK, Best LG, Boerwinkle E, Howard BV, et al. Normal limits in relation to age, body size and gender of two-dimensional echocardiographic aortic root dimensions in persons ≥15 years of age. Am J Cardiol. 2012;110:1189–94. - PMC - PubMed
    1. Asch FM, Yuriditsky E, Prakash SK, Roman MJ, Weinsaft JW, Weissman G, et al. The need for standardized methods for measuring the aorta:Multimodality core lab experience from the GenTAC registry. JACC Cardiovasc Imaging. 2016;9:219–26. - PMC - PubMed

LinkOut - more resources