Aortic Cross-Sectional Area/Height Ratio and Outcomes in Patients with Bicuspid Aortic Valve and a Dilated Ascending Aorta

Ahmad Masri, Vidyasagar Kalahasti, Lars G. Svensson, Alaa Alashi, Paul Schoenhagen, Eric E. Roselli, Douglas R. Johnston, L. Leonardo Rodriguez, Brian P. Griffin, Milind Y. Desai

Research output: Contribution to journalArticlepeer-review

37 Scopus citations


Background - In patients with bicuspid aortic valve and dilated proximal ascending aorta, we sought to assess (1) factors associated with increased longer-term cardiovascular mortality and (2) incremental prognostic use of indexing aortic root to patient height. Methods and Results - We studied 969 consecutive bicuspid aortic valve patients (50±13 years; 87% men) with proximal aorta ≥4 cm, who also had a gated contrast-enhanced thoracic computed tomography or magnetic resonance angiography. A ratio of ascending aortic area/height was calculated on tomography, and ≥10 cm 2 /m was considered abnormal, as previously reported. Society of Thoracic Surgeons score and cardiovascular death were recorded. Greater than or equal to III+ aortic regurgitation and severe aortic stenosis were seen in 37% and 10%, respectively. Society of Thoracic Surgeons score and right ventricular systolic pressure were 2±3 and 15±16 mm Hg, respectively. Abnormal ascending aortic area/height ratio was noted in 33%; 44% underwent ascending aortic surgery at 34 days. At 10.8 years (interquartile range, 9.6-12.3), 82 (9%) died (0.4% in-hospital postoperative mortality). On multivariable Cox survival analysis, ascending aortic area/height ratio (hazard ratio, 2; 95% confidence interval, 1.20-3.35) was associated with cardiovascular death, whereas aortic surgery (hazard ratio, 0.46; confidence interval, 0.26-0.80) was associated with improved survival (both P<0.01). Of the 405 patients with ascending aortic diameter of 4.5 to 5.5 cm, 64% had an abnormal ascending aortic area/height ratio, and 70% deaths occurred in patients with an abnormal ratio. Conclusions - In bicuspid aortic valve patients with dilated proximal ascending aorta, ascending aortic area/height ratio was independently associated with cardiovascular death.

Original languageEnglish (US)
Article numbere006249
JournalCirculation: Cardiovascular Imaging
Issue number6
StatePublished - Jun 1 2017
Externally publishedYes


  • aneurysm
  • aorta
  • blood pressure
  • heart valve diseases
  • magnetic resonance angiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine


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