Aortic & peripheral vascular disease
The aortic paradox: a nationwide analysis of 523 994 individual echocardiograms exploring fatal aortic dissection
Authors' conclusion
Although severe aortic dilatation is associated with a near-30-fold increase in fatal dissections, severely dilated aortas are implicated in only 2.3-24.4% of fatal dissections.
Study context
- Population
- Patients in the National Echo Database of Australia, stratified by absolute, height-indexed and body surface area (BSA)-indexed aortic dimensions; 52.4% male, median age 64 yearsnationwide echo database
- Participants
- 460,992 / 53,402 / 10,029 / 572
- Exposure
- Mild, moderate and severe aortic dilation vs normal aortic dimensions
- Normaln = 460,992reference
- Mild dilationn = 53,402
- Moderate dilationn = 10,029
- Severe dilationn = 572
- Outcome
- Fatal thoracic aortic dissection (ICD-10-AM I71) via linkage with the National Death Index
- Follow-up
- Median 6.9 years
Methodological detailsnationwide, registry linkage
- Nationwide
- Registry linkage
Main finding
As reported in the abstract
Fatal aortic dissection
Normal
610
events
Mild dilation
215
events
Moderate dilation
53
events
Severe dilation
21
events
Each group vs normalOdds ratio (95% CI)
Mild dilation
3.05(2.61–3.56)
Moderate dilation
4.0(3.02–5.30)
Severe dilation
28.72(18.44–44.72)
- Total fatal aortic dissections
- 899
- Fatal dissections in non-severely dilated aortas
- 97.7%
Observational data: associations, not effects.
Further findings
Share of fatal dissections due to severe dilation (sensitivity analysis)
- Severe aortic dilation responsible for at most
- 24.4%
- Results robust for absolute, height-indexed or BSA-indexed measurements
Original publication
The aortic paradox: a nationwide analysis of 523 994 individual echocardiograms exploring fatal aortic dissection. Eur Heart J Cardiovasc Imaging. Published 29 May 2024. doi:10.
Summarised from the published abstract; every number is checked against it