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Aortic root diameter and risk of cardiovascular events in a general population: data from the PAMELA study

Cuspidi, Cesarea,b; Facchetti, Ritaa; Bombelli, Michelea; Re, Annalisaa; Cairoa, Matteoa; Sala, Carlac; Tadic, Marijanad; Grassi, Guidoa,e; Mancia, Giuseppea,b

doi: 10.1097/HJH.0000000000000264

Aim: Data on the association of aortic root diameter (ARD), as assessed by echocardiography, with incident cardiovascular morbidity and mortality in the general population, are scanty and limited to elderly individuals. Thus, we investigated the value of ARD in predicting cardiovascular events in the Pressioni Arteriose Monitorate E Loro Associazioni population.

Methods: At entry, 1860 participants (mean age 50 ± 14, 50.6% men) underwent diagnostic tests including laboratory investigations, office and out-of-office blood pressure (BP) measurements (home and 24-h ambulatory BP monitoring), and echocardiography. ARD was measured at the level of Valsalva's sinuses and indexed to body surface area and height.

Results: Over a follow-up of 148 months, 137 nonfatal or fatal cardiovascular events were documented. After adjustment for age, sex, BP, fasting blood glucose, total cholesterol, smoking status, previous cardiovascular disease, and use of antihypertensive drugs, ARD/height [hazard ratio for 1 unit increase = 2.62, 95% confidence interval (CI) 1.19–5.75, P = 0.01], but not absolute ARD (hazard ratio 1.44, 95% CI 0.89–2.39, P = 0.13) neither ARD/body surface area (hazard ratio 2.09, 95% CI 0.96–4.55, P = 0.06) predicted the increased risk of cardiovascular events. The association between left ventricular hypertrophy and AR dilatation was a stronger predictor of cardiovascular prognosis than left ventricular hypertrophy alone.

Conclusions: Our results for the first time show that ARD indexed to height is predictive of incident nonfatal and fatal cardiovascular events among middle-aged individuals in the community and support the view that assessment of ARD in addition to left ventricular mass may refine cardiovascular risk stratification and preventive strategies in the general population.

aDepartment of Health Science, University of Milano-Bicocca

bIstituto Auxologico Italiano IRCCS

cDepartment of Clinical Sciences and Community Health University of Milano and Fondazione Ospedale Maggiore Policlinico, Milan, Italy

dUniversity Clinical Hospital Centre ‘Dragisa Misovic’, Belgrade, Serbia

eIRCCS Multimedica, Sesto San Giovanni, Milan, Italy

Correspondence to Professor Cesare Cuspidi, Istituto Auxologico Italiano, Clinical Research Unit, Viale della Resistenza 23, 20036 Meda, Italy.Tel: +39 0362 772433; fax: +39 0362 772416; e-mail:

Abbreviations: ARD, aortic root diameter; BP, blood pressure; BSA, body surface area; CI, confidence interval; LVH, left ventricular hypertrophy

Received 1 February, 2014

Revised 8 May, 2014

Accepted 9 May, 2014

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins