The New Dimension In Aortic Measurements-Use Of The Inner Edge Measurement For The Aorta Root In Healthy Adults By Echocardioraphy

Objective:The aim of this study was to investigate the aorta root diameters for adult by TTE taking the inner edge-to-inner edge in 301 healthy subjects and to study the impact of age,gender,and body surface area(BSA)on the aorta root.Methods:We enrolled 306 subjects who were referred to General Hospital of Tisco physical examination center and outpatient clinic as part of screening program for primary prevention of cardiovascular diseases.Exclusion criteria were coronary artery disease,systemic arterial hypertension,diabetes mellitus,valvular or congenital heart disease,bicuspid aortic valve,congestive heart failure,cardiomyopathies,sinus tachycardia,any other endocrine disease,pregnant and use of illicit drugs,physical examination and clinical assessment were normal,body mass index <28kg/m2,5 were excluded for inadequate echocardiographic image quality.Our final study population therefore consisted of 301 healthy subjects(mean age 45.76±15.8years,range 18 to 90 years,146 men [49%]).The study was approved by the institution ’s Ethics Board General Hospital of Tisco,and informed consent was obtained from the participants.The enrolled subjects were grouped by gender in two and grouped by age in five.Standardized TTE examinations were performed in all the subjects.The diameters of the aortic root should be obtained from the parasternal long-axis view.The sinuses of Valsalva(AoS),the sinotubular junction(AoST),and the proximal ascending aorta(AAo)should be made at end-diastole,while the aortic annulus(AoA)should be measured at midsystole,in a strictly perpendicular plane to the long axis of the aorta using the inner edge to inner edge convention.Specific measurements were made by the average of 5cardiac cycles.M-mode measurements,performed in the parasternal long-axis view with the patient in the left lateral position,included left ventricular internal diameter in diastole and systole.Demographics and clinical characteristics,LV dimensions,and aortic diameters,both absolute and relative to BSA,are presented as mean±SD and were tested by unpaired t test to evaluate differences between genders.Analizing the impact of age,gender,and BSA,height and weight on the aorta root demension by multivariate models.Reproducibility of aortic measurements was determined in 30 subjects randomly selected.The interobserver and intraobserver variabilities were examined using both Pearson bivariate 2-tailed correlations and Bland-Altman analysis.Two-tailed p value<0.05 was considered statistically significant.Results:The ninety-fifth percentile cut-off values of the absolute aortic diameters defining the upper physiological limits in men and women were AoA,20.93 and 19.12 mm;AoS,33.02 and 30.72 mm;AoST,28.50 and 27.72 mm;and AAo,30.67 and 30.50 mm,respectively.The absolute aortic diameters were significantly greater in men than in women at all levels,whereas BSA-indexed the AoST and AAo were greater in women(P=0.03、0.001).In the multivariate models,aortic diameters were independently associated with age,gender,and BSA(R2 ranged between 0.19 and 0.37),age was not associated with the aortic annlus(P=0.84).The intraobserver variability analysis revealed Pearson correlations as follows: r = 0.84(p <0.0001)for the aortic annulus,r =0.85(p<0.0001)for the sinuses of Valsalva,r = 0.87(p<0.0001)for the sinotubular junction,and r =0.84(p<0.0001)for the maximum diameter of the proximal ascending aorta.The Bland-Altman analysis gave a 95% confidence interval of 0.5 ± 2.35 mm for the aortic annulus,0.5 ± 2.35 mm for the sinuses of Valsalva,0.6 ± 3.35 mm for the sinotubular junction,and 0.1±2.8mm for the maximum diameter of the proximal ascending aorta.For interobserver variability,Pearson correlations were as follows: for the aortic annulus,r =0.87(p <0.0001);for the sinuses of Valsalva,r =0.79(p <0.0001);for the sinotubular junction,r =0.81(p <0.0001);and for the maximum diameter of the proximal ascending aorta,r = 0.77(p <0.0001).The Bland-Altman analysis gave a 95% confidence interval of1.2 ± 2.1mm for the aortic annulus,0.6± 2.1mm for the sinuses of Valsalva,0.6 ±3.7mm for the sinotubular junction,and 1.0 ± 4.8mm for the maximum diameter of the proximal ascending aorta.Conclusion:The data presented permit the creation of ables suggesting reference ranges for the aortic measurements.The diameters of AoS,AoST and AAo were lager with aging,which is critically important for preprocedural planning,intraprocedural guidance,and postprocedural assessment.