Journal of the Korean Society of Radiology (대한영상의학회지)

The Korean Society of Radiology (대한영상의학회)
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Aortic Unfolding Measurement Using Non-Contrast Cardiac CT: Normal Range of Low-Risk Subjects

관상동맥 석회화 CT에서 측정한 대동맥 전개: 저위험 환자군에서의 정상 범위

  • Ji Won Lee (Department of Radiology, Medical Research Institute, Pusan National University Hospital) ;
  • Byoung Wook Choi (Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine)
  • 이지원 (부산대학교병원 영상의학과) ;
  • 최병욱 (연세대학교 의과대학 세브란스병원 영상의학과)
  • Received : 2021.03.30
  • Accepted : 2021.05.25
  • Published : 2022.03.01
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Abstract

Purpose This study aimed to assess the factors influencing aortic unfolding (AU) defined by aortic width on coronary artery calcium (CAC) scan and determine the normal limits for AU. Materials and Methods In this retrospective study, we measured AU in 924 asymptomatic subjects who underwent CAC scanning during routine health screening from June 2015 to June 2018. Multivariate regression analysis was used to evaluate the factors influencing AU. After the exclusion of subjects with risk factors associated with AU, 283 subjects were included in the analysis of normal values of AU. Mean AU, standard deviation, and upper normal limit were calculated. Results Sex, age, CAC score, body mass index, body surface area, hypertension, left ventricular hypertrophy, plasma creatinine, and smoking were significantly associated with AU. The mean AU was 102.2 ± 12.8 mm for men and 93.1 ± 10.7 mm for women. AU increased with advancing age (9.6 mm per decade). Conclusion AU determined from a single measurement on CAC scans was associated with cardiovascular risk factors. The normal limits of AU were defined by age, sex, and body surface area in low-risk subjects in this study.

목적 이 연구의 목적은 관상동맥 석회화 CT에서 측정한 대동맥 폭으로 정의한 대동맥 전개(aortic unfolding)에 영향을 미치는 요인을 평가하고 대동맥 전개의 정상 범위를 알아보는 것이다. 대상과 방법 이 후향적 연구에서 우리는 2015년 6월부터 2018년 6월까지 건강검진을 목적으로 관상동맥 석회화 CT를 시행 받은 924명의 무증상 성인에서 대동맥 전개를 측정했다. 다변량 회귀 분석을 사용하여 대동맥 전개에 영향을 미치는 요인들을 평가했다. 그 후 대동맥 전개와 관련된 위험 요소가 있는 성인을 제외되고 283명의 성인이 대동맥 전개의 정상값 분석에 포함되었다. 대동맥 전개의 평균, 표준 편차 및 상한값이 계산되었다. 결과 성별, 나이, 관상동맥 석회화 점수, 체질량지수, 체 표면적, 고혈압, 좌심실 비대, 혈장 크레아티닌, 흡연은 대동맥 전개와 유의한 관계가 있었다. 평균 대동맥 전개값은 남성의 경우 102.2 ± 12.8 mm, 여성의 경우 93.1 ± 10.7 mm였다. 대동맥 전개값은 연령이 증가할 수록(10년당 9.6 mm)으로 증가했다. 결론 관상동맥 석회화 CT에서 측정된 대동맥 전개는 심혈관 위험 인자들과 관련이 있었다. 또한 본 연구에서 저위험군에서 대동맥 전개의 정상 범위를 나이, 성별 및 체표표면적당으로 정의하였다.

Keywords

Acknowledgement

This work was supported by clinical research grant from Pusan National University Hospital in 2020.

References

  1. O'Rourke M, Farnsworth A, O'Rourke J. Aortic dimensions and stiffness in normal adults. JACC Cardiovasc Imaging 2008;1:749-751 
  2. Gardin JM, Arnold AM, Polak J, Jackson S, Smith V, Gottdiener J. Usefulness of aortic root dimension in persons > or = 65 years of age in predicting heart failure, stroke, cardiovascular mortality, all-cause mortality and acute myocardial infarction (from the Cardiovascular Health Study). Am J Cardiol 2006;97:270-275 
  3. Lee JW, Hur J, Kim YJ, Lee HJ, Nam JE, Kim HY, et al. Aortic unfolding determined using non-contrast cardiac computed tomography: correlations with age and coronary artery calcium score. PLoS One 2014;9:e95887 
  4. Lin FY, Devereux RB, Roman MJ, Meng J, Jow VM, Jacobs A, et al. Assessment of the thoracic aorta by multidetector computed tomography: age- and sex-specific reference values in adults without evident cardiovascular disease. J Cardiovasc Comput Tomogr 2008;2:298-308 
  5. Mosteller RD. Simplified calculation of body-surface area. N Engl J Med 1987;317:1098 
  6. Antikainen R, Grodzicki T, Palmer AJ, Beevers DG, Coles EC, Webster J, et al. The determinants of left ventricular hypertrophy defined by Sokolow-Lyon criteria in untreated hypertensive patients. J Hum Hypertens 2003;17:159-164 
  7. Mohlenkamp S, Schmermund A, Lehmann N, Roggenbuck U, Dragano N, Stang A, et al. Subclinical coronary atherosclerosis and resting ECG abnormalities in an unselected general population. Atherosclerosis 2008;196:786-794 
  8. Blacher J, Asmar R, Djane S, London GM, Safar ME. Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients. Hypertension 1999;33:1111-1117 
  9. Agatston AS, Janowitz WR, Hildner FJ, Zusmer NR, Viamonte M Jr, Detrano R. Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990;15:827-832 
  10. Budoff MJ, Nasir K, McClelland RL, Detrano R, Wong N, Blumenthal RS, et al. Coronary calcium predicts events better with absolute calcium scores than age-sex-race/ethnicity percentiles: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol 2009;53:345-352 
  11. Jensen MD, Ryan DH, Apovian CM, Ard JD, Comuzzie AG, Donato KA, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation 2014;129:S102-S138 
  12. Hickson SS, Butlin M, Graves M, Taviani V, Avolio AP, McEniery CM, et al. The relationship of age with regional aortic stiffness and diameter. JACC Cardiovasc Imaging 2010;3:1247-1255 
  13. Inoue N, Maeda R, Kawakami H, Shokawa T, Yamamoto H, Ito C, et al. Aortic pulse wave velocity predicts cardiovascular mortality in middle-aged and elderly Japanese men. Circ J 2009;73:549-553 
  14. O'Rourke MF, Hashimoto J. Mechanical factors in arterial aging: a clinical perspective. J Am Coll Cardiol 2007;50:1-13 
  15. Sugawara J, Hayashi K, Yokoi T, Tanaka H. Age-associated elongation of the ascending aorta in adults. JACC Cardiovasc Imaging 2008;1:739-748 
  16. Redheuil A, Yu WC, Mousseaux E, Harouni AA, Kachenoura N, Wu CO, et al. Age-related changes in aortic arch geometry: relationship with proximal aortic function and left ventricular mass and remodeling. J Am Coll Cardiol 2011;58:1262-1270 
  17. Craiem D, Chironi G, Casciaro ME, Redheuil A, Mousseaux E, Simon A. Three-dimensional evaluation of thoracic aorta enlargement and unfolding in hypertensive men using non-contrast computed tomography. J Hum Hypertens 2013;27:504-509 
  18. Wolak A, Gransar H, Thomson LE, Friedman JD, Hachamovitch R, Gutstein A, et al. Aortic size assessment by noncontrast cardiac computed tomography: normal limits by age, gender, and body surface area. JACC Cardiovasc Imaging 2008;1:200-209 
  19. Chironi G, Orobinskaia L, Megnien JL, Sirieix ME, Clement-Guinaudeau S, Bensalah M, et al. Early thoracic aorta enlargement in asymptomatic individuals at risk for cardiovascular disease: determinant factors and clinical implication. J Hypertens 2010;28:2134-2138 
  20. Kannel WB. Left ventricular hypertrophy as a risk factor: the Framingham experience. J Hypertens Suppl 1991;9:S3-S8; discussion S8-S9 
  21. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Left ventricular mass and incidence of coronary heart disease in an elderly cohort. The Framingham Heart Study. Ann Intern Med 1989;110:101-107 
  22. Kannel WB, Cobb J. Left ventricular hypertrophy and mortality--results from the Framingham Study. Cardiology 1992;81:291-298 
  23. Craiem D, Chironi G, Redheuil A, Casciaro M, Mousseaux E, Simon A, et al. Aging impact on thoracic aorta 3D morphometry in intermediate-risk subjects: looking beyond coronary arteries with non-contrast cardiac CT. Ann Biomed Eng 2012;40:1028-1038 
  24. Kurugol S, San Jose Estepar R, Ross J, Washko GR. Aorta segmentation with a 3D level set approach and quantification of aortic calcifications in non-contrast chest CT. Annu Int Conf IEEE Eng Med Biol Soc 2012;2012:2343-2346