{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:51:51Z","timestamp":1791366711239,"version":"4.3.1"},"reference-count":7,"publisher":"Georg Thieme Verlag KG","issue":"07","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Thorac Cardiovasc Surg"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Clinical guidelines for thoracic aortopathy rely on absolute diameter thresholds to guide surveillance and prophylactic intervention. These thresholds, derived largely from Western cohorts, are applied globally, including in populations with smaller baseline vascular dimensions.<\/jats:p>\n                  <jats:p>We performed a counterfactual, denominator-based analysis comparing the distribution of ascending aortic diameter and its body surface area (BSA)-indexed equivalent in a South Asian general population (n\u2009=\u20092,000) with diameters at presentation in a cohort of acute Stanford type A aortic dissection (ATAAD) patients (n\u2009=\u200971), with Bayesian 95% credible intervals around exposure ratios.<\/jats:p>\n                  <jats:p>The general population showed a narrow distribution (median 30.2\u2009mm; 95th percentile 37.6\u2009mm; mean indexed diameter 18.5\u2009\u00b1\u20093.1\u2009mm\/m2), with under 1% reaching the 45\u2009mm guideline threshold. Dissections occurred across a broad diameter range (median 52\u2009mm; indexed median 28.0\u2009mm\/m2, interquartile range [IQR] 22.1\u201334.0\u2009mm\/m2) and were disproportionately concentrated in the extreme right tail of both distributions.<\/jats:p>\n                  <jats:p>Guideline-based absolute diameter thresholds correspond to an extremely small fraction of this South Asian population, yet dissections remain concentrated in the extreme right tail, a pattern preserved and amplified after BSA indexing. These findings support population-aware interpretation of aortic size thresholds.<\/jats:p>","DOI":"10.1055\/a-2921-6578","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T23:04:51Z","timestamp":1785452691000},"page":"545-550","source":"Crossref","is-referenced-by-count":0,"title":["Applicability of Guideline-Based Aortic Intervention Thresholds in the Indian Population"],"prefix":"10.1055","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9981-8336","authenticated-orcid":false,"given":"Nimrat","family":"Grewal","sequence":"additional","affiliation":[{"name":"Amsterdam University Medical Center, University of Amsterdam, Netherlands","place":["Amsterdam"],"department":["Department of Cardiothoracic Surgery"]},{"name":"Yale New Haven Hospital, Connecticut, United States","place":["New Haven"],"department":["Aortic Institute"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Idhrees","sequence":"additional","affiliation":[{"name":"SRM Institutes for Medical Science (SIMS Hospital), Tamil Nadu, India","place":["Chennai"],"department":["Institute of Cardiac and Aortic Disorders (ICAD)"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jedidiah","family":"Samraj","sequence":"additional","affiliation":[{"name":"SRM Institutes for Medical Science (SIMS Hospital), Tamil Nadu, India","place":["Chennai"],"department":["Institute of Cardiac and Aortic Disorders (ICAD)"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bashi","family":"Velayudhan","sequence":"additional","affiliation":[{"name":"SRM Institutes for Medical Science (SIMS Hospital), Tamil Nadu, India","place":["Chennai"],"department":["Institute of Cardiac and Aortic Disorders (ICAD)"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"issue":"02","key":"ref1","doi-asserted-by":"crossref","first-page":"ezad426","DOI":"10.1093\/ejcts\/ezad426","article-title":"EACTS\/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ","volume":"65","author":"M Czerny","year":"2024","journal-title":"Eur J Cardiothorac Surg"},{"issue":"12","key":"ref2","first-page":"e76703","article-title":"Ethnic differences in ascending aorta dimensions and dilatation rates: a systematic review","volume":"16","author":"A Ansari","year":"2024","journal-title":"Cureus"},{"issue":"01","key":"ref3","doi-asserted-by":"crossref","first-page":"e003808","DOI":"10.1136\/openhrt-2025-003808","article-title":"Ethnic variation in thoracic aortic dimensions in the general population: a comparison between Indian and Dutch populations","volume":"13","author":"N Bacour","year":"2026","journal-title":"Open Heart"},{"issue":"05","key":"ref4","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1007\/s12055-025-02173-6","article-title":"Establishing reference values for aortic dimensions in the general Indian population and implications for global standards","volume":"42","author":"M Idhrees","year":"2026","journal-title":"Indian J Thorac Cardiovasc Surg"},{"issue":"10","key":"ref5","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1161\/CIRCULATIONAHA.107.702720","article-title":"Aortic diameter >or = 5.5\u2009cm is not a good predictor of type A aortic dissection: observations from the International Registry of Acute Aortic Dissection (IRAD)","volume":"116","author":"L A Pape","year":"2007","journal-title":"Circulation"},{"issue":"04","key":"ref6","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1159\/000381281","article-title":"Aortic size distribution in the general population: explaining the size paradox in aortic dissection","volume":"131","author":"V Paruchuri","year":"2015","journal-title":"Cardiology"},{"issue":"13","key":"ref7","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1016\/j.jacc.2013.12.028","article-title":"How does the ascending aorta geometry change when it dissects?","volume":"63","author":"B Rylski","year":"2014","journal-title":"J Am Coll Cardiol"}],"container-title":["The Thoracic and Cardiovascular Surgeon"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.thieme-connect.de\/products\/ejournals\/pdf\/10.1055\/a-2921-6578.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T09:07:32Z","timestamp":1791364052000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.thieme-connect.de\/DOI\/DOI?10.1055\/a-2921-6578"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,30]]},"references-count":7,"journal-issue":{"issue":"07","published-online":{"date-parts":[[2026,10,6]]},"published-print":{"date-parts":[[2026,10]]}},"URL":"https:\/\/doi.org\/10.1055\/a-2921-6578","archive":["Portico","CLOCKSS"],"relation":{},"ISSN":["0171-6425","1439-1902"],"issn-type":[{"value":"0171-6425","type":"print"},{"value":"1439-1902","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,30]]}}}