{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T14:42:52Z","timestamp":1764859372728,"version":"3.37.3"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"12","license":[{"start":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T00:00:00Z","timestamp":1627516800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T00:00:00Z","timestamp":1627516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["TH1106\/5-1; AA93\/2-1"],"award-info":[{"award-number":["TH1106\/5-1; AA93\/2-1"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001674","name":"Fondation Leducq","doi-asserted-by":"publisher","award":["16 CVD 03"],"award-info":[{"award-number":["16 CVD 03"]}],"id":[{"id":"10.13039\/501100001674","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010767","name":"Innovative Medicines Initiative","doi-asserted-by":"publisher","award":["116074"],"award-info":[{"award-number":["116074"]}],"id":[{"id":"10.13039\/501100010767","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Universit\u00e4tsklinikum Hamburg-Eppendorf (UKE)"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Cardiovasc Imaging"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Here we generate up-to-date reference values of transthoracic echocardiographic aortic root dimensions matched by sex, age, and body surface area (BSA) derived from the population-based Hamburg City Health Study (HCHS) cohort. In 1687 healthy subjects (mean age 57.1\u2009\u00b1\u20097.7, 681 male and 1006 female), derived from the first prospectively-recruited 10,000 HCHS participants, dimensions of the aortic root were measured in systole and diastole using state-of-the-art 2-dimensional transthoracic echocardiography. Diameters were assessed at four levels: aortic annulus, Sinus of Valsalva, sinotubular junction, and ascending aorta. Female sex was associated with significantly smaller absolute aortic root dimensions, while indexing for BSA resulted in a reverse effect at all levels. There was a strong age dependency of all aortic root diameters as well as aortic annulus\/sinotubular junction ratio for both sexes. Multivariate analysis revealed age, sex, weight, height, and BSA to be significant determinants of aortic root size. Finally, formulas were generated for the calculation of individual aortic root reference values considering age, sex, weight, and height. We provide population-based reference values of aortic root diameters based on a standardized transthoracic echocardiographic protocol of the population-based HCHS which may support the diagnosis, monitoring, and treatment of aortic root disease.<\/jats:p>","DOI":"10.1007\/s10554-021-02354-5","type":"journal-article","created":{"date-parts":[[2021,7,29]],"date-time":"2021-07-29T10:03:40Z","timestamp":1627553020000},"page":"3513-3524","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Transthoracic echocardiographic reference values of the aortic root: results from the Hamburg City Health Study"],"prefix":"10.1007","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6302-8671","authenticated-orcid":false,"given":"Jan-Per","family":"Wenzel","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elina","family":"Petersen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julius","family":"Nikorowitsch","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliana","family":"Senftinger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Sinning","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Theissen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johannes","family":"Petersen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hermann","family":"Reichenspurner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Evaldas","family":"Girdauskas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,7,29]]},"reference":[{"issue":"6","key":"2354_CR1","doi-asserted-by":"publisher","first-page":"830","DOI":"10.1016\/j.amjcard.2006.10.048","volume":"99","author":"CL Reid","year":"2007","unstructured":"Reid CL, Anton-Culver H, Yunis C, Gardin JM (2007) Prevalence and clinical correlates of isolated mitral, isolated aortic regurgitation, and both in adults aged 21 to 35 years (from the CARDIA study). Am J Cardiol 99(6):830\u2013834","journal-title":"Am J Cardiol"},{"issue":"4","key":"2354_CR2","doi-asserted-by":"publisher","first-page":"316","DOI":"10.1016\/S0894-7317(14)80315-5","volume":"3","author":"JD Seder","year":"1990","unstructured":"Seder JD, Burke JF, Pauletto FJ (1990) Prevalence of aortic regurgitation by color flow Doppler in relation to aortic root size. J Am Soc Echocardiogr 3(4):316\u2013319","journal-title":"J Am Soc Echocardiogr"},{"issue":"5","key":"2354_CR3","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1111\/j.1540-8175.2009.01072.x","volume":"27","author":"CL Lai","year":"2010","unstructured":"Lai CL, Chien KL, Hsu HC, Su TC, Chen MF, Lee YT (2010) Aortic root dimension as an independent predictor for all-cause death in adults < 65 years of age (from the chin-shan community cardiovascular cohort study). Echocardiography 27(5):487\u2013495","journal-title":"Echocardiography"},{"issue":"4","key":"2354_CR4","doi-asserted-by":"publisher","first-page":"358","DOI":"10.1136\/hrt.58.4.358","volume":"58","author":"TE Guiney","year":"1987","unstructured":"Guiney TE, Davies MJ, Parker DJ, Leech GJ, Leatham A (1987) The aetiology and course of isolated severe aortic regurgitation: A clinical, pathological, and echocardiographic study. Heart 58(4):358\u2013368","journal-title":"Heart"},{"issue":"2","key":"2354_CR5","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1016\/j.amjcard.2005.08.039","volume":"97","author":"JM Gardin","year":"2006","unstructured":"Gardin JM, Arnold AM, Polak J, Jackson S, Smith V, Gottdiener J (2006) Usefulness of aortic root dimension in persons \u226565 years of age in predicting heart failure, stroke, cardiovascular mortality, all-cause mortality and acute myocardial infarction (from the Cardiovascular Health Study). Am J Cardiol 97(2):270\u2013275","journal-title":"Am J Cardiol"},{"issue":"8","key":"2354_CR6","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1016\/0002-9149(89)90430-X","volume":"64","author":"MJ Roman","year":"1989","unstructured":"Roman MJ, Devereux RB, Kramer-Fox R, O\u2019Loughlin J (1989) Two-dimensional echocardiographic aortic root dimensions in normal children and adults. Am J Cardiol 64(8):507\u2013512","journal-title":"Am J Cardiol"},{"issue":"6","key":"2354_CR7","doi-asserted-by":"publisher","first-page":"793","DOI":"10.1016\/S0894-7317(05)80003-3","volume":"8","author":"RS Vasan","year":"1995","unstructured":"Vasan RS, Larson MG, Benjamin EJ, Levy D (1995) Echocardiographic reference values for aortic root size: The Framingham Heart Study. J Am Soc Echocardiogr 8(6):793\u2013800","journal-title":"J Am Soc Echocardiogr"},{"issue":"8","key":"2354_CR8","doi-asserted-by":"publisher","first-page":"1189","DOI":"10.1016\/j.amjcard.2012.05.063","volume":"110","author":"RB Devereux","year":"2012","unstructured":"Devereux RB, De Simone G, Arnett DK, Best LG, Boerwinkle E, Howard BV et al (2012) Normal limits in relation to age, body size and gender of two-dimensional echocardiographic aortic root dimensions in persons > 15 years of age. Am J Cardiol 110(8):1189\u20131194. https:\/\/doi.org\/10.1016\/j.amjcard.2012.05.063","journal-title":"Am J Cardiol"},{"issue":"2","key":"2354_CR9","first-page":"40","volume":"9","author":"DD Savage","year":"1987","unstructured":"Savage DD, Garrison RJ, Kannel WB, Anderson SJ, Feinleib M, Castelli WP (1987) Considerations in the use of echocardiography in epidemiology. The Framingham Study. Hypertension 9(2):40\u201344","journal-title":"Hypertension"},{"issue":"2","key":"2354_CR10","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1007\/s10654-019-00577-4","volume":"35","author":"A Jagodzinski","year":"2020","unstructured":"Jagodzinski A, Johansen C, Koch-Gromus U, Aarabi G, Adam G, Anders S et al (2020) Rationale and design of the Hamburg City Health Study. Eur J Epidemiol 35(2):169\u2013181","journal-title":"Eur J Epidemiol"},{"issue":"2","key":"2354_CR11","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1016\/j.echo.2014.11.015","volume":"28","author":"SA Goldstein","year":"2015","unstructured":"Goldstein SA, Evangelista A, Abbara S, Arai A, Asch FM, Badano LP et al (2015) Multimodality imaging of diseases of the thoracic aorta in adults: from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28(2):119\u2013182","journal-title":"J Am Soc Echocardiogr"},{"issue":"3","key":"2354_CR12","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1016\/j.echo.2014.10.003","volume":"16","author":"RM Lang","year":"2015","unstructured":"Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American society of echocardiography and the European association of cardiovascular imaging. J Am Soc Echocardiogr 16(3):233\u2013271. https:\/\/doi.org\/10.1016\/j.echo.2014.10.003","journal-title":"J Am Soc Echocardiogr"},{"key":"2354_CR13","doi-asserted-by":"publisher","DOI":"10.1007\/s10554-021-02337-6","author":"JP Wenzel","year":"2021","unstructured":"Wenzel JP, Petersen E, Nikorowitsch J, M\u00fcller J, K\u00f6lbel T (2021) Aortic root dimensions as a correlate for aortic regurgitation\u2019 s severity. Int J Cardiovasc Imaging. https:\/\/doi.org\/10.1007\/s10554-021-02337-6","journal-title":"Int J Cardiovasc Imaging"},{"key":"2354_CR14","doi-asserted-by":"publisher","first-page":"2739","DOI":"10.1093\/eurheartj\/ehx391","volume":"38","author":"CS Eacts","year":"2017","unstructured":"Eacts CS, Germany CH, Rosenhek R, France EL, Rodriguez D, Tornos P et al (2017) 2017 ESC\/EACTS Guidelines for the management of valvular heart disease The Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European. Eur Heart J 38:2739\u20132786","journal-title":"Eur Heart J"},{"issue":"2","key":"2354_CR15","doi-asserted-by":"publisher","first-page":"420","DOI":"10.1037\/0033-2909.86.2.420","volume":"86","author":"PE Shrout","year":"1979","unstructured":"Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86(2):420\u2013428","journal-title":"Psychol Bull"},{"issue":"5","key":"2354_CR16","doi-asserted-by":"publisher","first-page":"298","DOI":"10.1016\/j.jcct.2008.08.002","volume":"2","author":"FY Lin","year":"2008","unstructured":"Lin FY, Devereux RB, Roman MJ, Meng J, Jow VM, Jacobs A et al (2008) Assessment of the thoracic aorta by multidetector computed tomography: age- and sex-specific reference values in adults without evident cardiovascular disease. J Cardiovasc Comput Tomogr 2(5):298\u2013308","journal-title":"J Cardiovasc Comput Tomogr"},{"issue":"5","key":"2354_CR17","doi-asserted-by":"publisher","first-page":"465","DOI":"10.1016\/j.echo.2010.03.019","volume":"23","author":"L Lopez","year":"2010","unstructured":"Lopez L, Colan SD, Frommelt PC, Ensing GJ, Kendall K, Younoszai AK et al (2010) Recommendations for Quantification Methods During the Performance of a Pediatric Echocardiogram: A Report From the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc Echocardiogr 23(5):465\u2013495","journal-title":"J Am Soc Echocardiogr"},{"issue":"2","key":"2354_CR18","doi-asserted-by":"publisher","first-page":"167","DOI":"10.1093\/ehjci\/jew053","volume":"18","author":"D Saura","year":"2017","unstructured":"Saura D, Dulgheru R, Caballero L, Bernard A, Kou S, Gonjilashvili N et al (2017) Two-dimensional transthoracic echocardiographic normal reference ranges for proximal aorta dimensions: results from the EACVI NORRE study. Eur Heart J Cardiovasc Imaging 18(2):167\u2013179","journal-title":"Eur Heart J Cardiovasc Imaging"},{"key":"2354_CR19","doi-asserted-by":"publisher","first-page":"1859","DOI":"10.1253\/circj.CJ-08-0171","volume":"72","author":"M Daimon","year":"2008","unstructured":"Daimon M, Watanabe H, Abe Y, Hirata K, Hozumi T, Ishii K et al (2008) Normal values of echocardiographic parameters in relation - the JAMP study. Circ J 72:1859\u20131866","journal-title":"Circ J"},{"issue":"4","key":"2354_CR20","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1016\/j.echo.2012.12.013","volume":"26","author":"O Mirea","year":"2013","unstructured":"Mirea O, Maffessanti F, Gripari P, Tamborini G, Muratori M, Fusini L et al (2013) Effects of aging and body size on proximal and ascending aorta and aortic arch: inner edge-to-inner edge reference values in a large adult population by two-dimensional transthoracic echocardiography. J Am Soc Echocardiogr 26(4):419\u2013427","journal-title":"J Am Soc Echocardiogr"},{"issue":"1","key":"2354_CR21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1476-7120-11-28","volume":"11","author":"MK Son","year":"2013","unstructured":"Son MK, Chang SA, Kwak JH, Lim HJ, Park SJ, Choi JO et al (2013) Comparative measurement of aortic root by transthoracic echocardiography in normal Korean population based on two different guidelines. Cardiovasc Ultrasound 11(1):1\u20138","journal-title":"Cardiovasc Ultrasound"},{"issue":"4","key":"2354_CR22","doi-asserted-by":"publisher","first-page":"415","DOI":"10.1093\/ehjci\/jet173","volume":"15","author":"D Muraru","year":"2014","unstructured":"Muraru D, Maffessanti F, Kocabay G, Peluso D, Bianco LD, Piasentini E et al (2014) Ascending aorta diameters measured by echocardiography using both leading edge-to-leading edge and inner edge-to-inner edge conventions in healthy volunteers. Eur Heart J Cardiovasc Imaging 15(4):415\u2013422","journal-title":"Eur Heart J Cardiovasc Imaging"},{"issue":"11","key":"2354_CR23","doi-asserted-by":"publisher","first-page":"1104","DOI":"10.1016\/j.hlc.2015.05.001","volume":"24","author":"BT Fitzgerald","year":"2015","unstructured":"Fitzgerald BT, Kwon A, Scalia GM (2015) The new dimension in aortic measurements - use of the inner edge measurement for the thoracic aorta in australian patients. Hear Lung Circ 24(11):1104\u20131110. https:\/\/doi.org\/10.1016\/j.hlc.2015.05.001","journal-title":"Hear Lung Circ"},{"issue":"6","key":"2354_CR24","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1016\/j.amjcard.2014.06.028","volume":"114","author":"O Vriz","year":"2014","unstructured":"Vriz O, Aboyans V, D\u2019Andrea A, Ferrara F, Acri E, Limongelli G et al (2014) Normal values of aortic root dimensions in healthy adults. Am J Cardiol 114(6):921\u2013927. https:\/\/doi.org\/10.1016\/j.amjcard.2014.06.028","journal-title":"Am J Cardiol"},{"key":"2354_CR25","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1161\/CIRCIMAGING.116.005292","volume":"9","author":"A Boraita","year":"2016","unstructured":"Boraita A, Heras M-E, Morales F, Marina-Breysse M, Canda A, Rabadan M et al (2016) Reference values of aortic root in male and female white elite athletes according to sport. Circ Cardiovasc Imaging 9:10","journal-title":"Circ Cardiovasc Imaging"},{"issue":"3","key":"2354_CR26","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1161\/01.CIR.91.3.734","volume":"91","author":"RS Vasan","year":"1995","unstructured":"Vasan RS, Larson MG, Levy D (1995) Determinants of echocardiographic aortic root size. The Framingham Heart Study. Circulation 91(3):734\u2013740","journal-title":"Circulation"}],"container-title":["The International Journal of Cardiovascular Imaging"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10554-021-02354-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10554-021-02354-5\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10554-021-02354-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,11,19]],"date-time":"2021-11-19T18:39:43Z","timestamp":1637347183000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10554-021-02354-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,29]]},"references-count":26,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["2354"],"URL":"https:\/\/doi.org\/10.1007\/s10554-021-02354-5","relation":{},"ISSN":["1569-5794","1573-0743"],"issn-type":[{"type":"print","value":"1569-5794"},{"type":"electronic","value":"1573-0743"}],"subject":[],"published":{"date-parts":[[2021,7,29]]},"assertion":[{"value":"27 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 July 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 July 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"EG reports honoraria from Edwards, Medtronic, LivaNova, and Aesculap, outside of the submitted work. SB reports honoraria from Abbott, Siemens, Thermo Fisher, and Roche, outside of the submitted work.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The authors do hereby declare that their study complies with the Declaration of Helsinki.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}}]}}