Aortic & peripheral vascular diseaseCohort study
Optimal Reclassification of Aortic Aneurysms
- Cohort study
Authors' conclusion
Indexed parameters, particularly CSAH, improve risk stratification beyond absolute diameters and highlight size-based differences in AA.
Study context
- Population
- Patients with ascending aortopathy (≥4 cm) undergoing both TTE and computed tomographic angiography (CTA)
- Participants
- 7,459 patients
- Exposure
- TTE vs CE-CTA for aortic measurement; absolute vs indexed aortic metrics for prognosis
- Outcome
- Composite of:
- Mortality
- Dissection
- Rupture
Main finding
As reported in the abstract
3.6 ± 3.6 years
Each group vs CE-CTAHazard ratio (95% CI)P value
Aortic diameter ≥5 cm
2.42(1.77–2.99)
P < 0.001AHI >3.20 cm/m
3.24(2.22–4.17)
P < 0.001CSAH ≥10 cm²/m
2.09(1.55–2.39)
P < 0.001- Composite events
- 865 (11.6%)
- Deaths
- 708 [9.5%]
- Aortic dissections
- 173 [2.3%]
- Ruptures
- 12 [0.2%]
Observational data: associations, not effects.
Further findings
TTE underestimation of aortic size vs CE-CTA (particularly aneurysms ≥5 cm)
- Aortic roots underestimated
- 58%
- Mid-ascending aortas underestimated
- 37%
Distribution of events in unoperated patients (n = 5,213)
- Events at diameter <5 cm
- 63%
- Events at AHI ≤3.21 cm/m
- 86%
- Events associated with CSAH ≥10 cm²/m
- 53%
Original publication
Optimal Reclassification of Aortic Aneurysms. JACC Cardiovasc Imaging. Published 13 July 2026. doi:10.1016/j.jcmg.2026.05.011
Summarised from the published abstract; every number is checked against it