Prevalence of Incidentally Identified Thoracic Aortic Dilations: Insights for Screening Criteria

• Published in: Canadian journal of cardiology 2019-07, Vol.35 (7), p.892-898
• Main Authors: Mori, Makoto, Bin Mahmood, Syed Usman, Yousef, Sameh, Shioda, Kayoko, Faggion Vinholo, Thais, Mangi, Abeel A., Elefteriades, John A., Geirsson, Arnar
• Format: Article
• Language: English
• Subjects: Age Factors; Aged; Aorta, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - diagnostic imaging; Aortic Aneurysm, Thoracic - epidemiology; Connecticut - epidemiology; Cross-Sectional Studies; Dilatation, Pathologic - diagnostic imaging; Dilatation, Pathologic - epidemiology; Dyslipidemias - epidemiology; Female; Humans; Hypertension - epidemiology; Incidental Findings; Male; Middle Aged; Prevalence; Sex Distribution; Tomography, X-Ray Computed
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2019.03.023

Systematic screening for ascending thoracic aortic aneurysms and dilations does not exist currently with unknown prevalence and diagnostic yields. We evaluated the prevalence of ascending thoracic aortic dilation. Computed tomography scans including the chest in adult patients carried out during 2016 were reviewed at our institution. Aortic dilation was defined as the ascending thoracic aorta diameter ≥ 4.0 cm, with sensitivity analyses using height-indexed values and thresholds of 3.5, 4.25, and 4.5 cm. The prevalence of aortic dilation was evaluated by age and sex. Potential diagnostic yield along the continuum of age threshold was calculated by sex. Of the 5662 scans from unique patients, the prevalence of aortic dilation was 2.1% overall, 3.2% for males and 0.9% for females. Patients with aneurysms were significantly older (70.2 ± 9.9 vs 58.3 ± 16.4 years, P < 0.001) and more likely to be male (81.0% vs 54.2%, P < 0.001). The highest diagnostic yield of aneurysm ≥ 4.5 cm in females occurred at the age threshold of ≥ 73 years, with the yield of 0.5%. The highest diagnostic yield of aneurysm ≥ 4.5 cm in males occurred at age ≥ 84 years, with the yield of 5.7%. In males, the diagnostic yields at age thresholds of ≥ 50, ≥ 60, and ≥ 70 years were 1.3%, 1.6%, and 2.2%, respectively. Aortic dilation was identified in 2.8% of individuals with age ≥ 50 years. In females, aneurysm was uncommon. In males, there was an incremental increase in the diagnostic yield with age. Male patients with age ≥ 50 years may be the demographic group with a high prevalence of dilation. En l’absence actuelle d’un dépistage systématique des anévrismes et des dilatations de l’aorte thoracique ascendante, la prévalence et le rendement diagnostique de ces anomalies sont inconnus. Nous avons évalué la prévalence de la dilatation de l’aorte thoracique ascendante. Nous avons passé en revue les tomodensitogrammes couvrant la région thoracique réalisés chez des patients adultes en 2016 dans notre établissement. La dilatation aortique a été définie par un diamètre de l’aorte thoracique ascendante ≥ 4,0 cm et les analyses de sensibilité ont utilisé des valeurs indexées en fonction de la hauteur et des seuils de 3,5, de 4,25 et de 4,5 cm. La prévalence de la dilatation aortique a été évaluée selon l’âge et selon le sexe. Le rendement diagnostique potentiel d’un bout à l’autre du continuum des seuils d’âge a été calculé selon le sexe. L’analyse des 5662 tomodensitogrammes, correspondant chacun