Relative Associations of Age, Height, and Weight on Sinus of Valsalva and Mid-Ascending Aorta: An Imaging and Epidemiology Study

Background: Prior studies show ascending aorta diameter varies with age, height and weight, but they did not evaluate relative influence of these variables on aortic diameter. Since height is genetically determined, and genetic disorders like Marfan syndrome are predominantly associated with sinus of Valsalva (SOV) dilation, we hypothesized height may have stronger association with SOV. Purpose: Based on anecdotal observation, since age, weight and obesity are acquired attributes, we hypothesized age, weight and body mass index may have greater association with mid-ascending aorta (MAA) diameter, even in normal patients. Methods: We evaluated echocardiographic studies of patients ≥ 15 years old that were done in the last 4 years to measure SOV and MAA diameter in normal patients (defined as: medical records and echocardiograms did not reveal any of the 28 aortic dilation risk factors listed in the American Heart Association 2010 guidelines). Results: Of 65,843 patients, 3,201 were identified as normal. SOV measurements were available in 2,046, MAA in 2,334. Age had stronger correlation with MAA (β = 0.50; r = 0.52; P \u3c 0.001) than SOV (β = 0.33; r = 0.35; P \u3c 0.001). Weight was similarly correlated with diameters of SOV (r = 0.37; P \u3c 0.001) and MAA (r = 0.37; P \u3c 0.001). Height had stronger correlation with SOV diameter (β = 0.41; r = 0.38; P \u3c 0.001) than MAA (β = 0.26; r = 0.25; P \u3c 0.001). Conclusion: These data suggest that in normal subjects, age, weight and body mass index have stronger associations with the mid-ascending aorta, whereas height has a stronger association with the sinus of Valsalva