{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T02:17:45Z","timestamp":1794449865059,"version":"4.9.1"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T00:00:00Z","timestamp":1716940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/501100001782","name":"Melbourne University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001782","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001173","name":"Cardiac Society of Australia and New Zealand","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001173","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009648","name":"NHF","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009648","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"NHMRC","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,9,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Increasing aortic dilation increases the risk of aortic dissection. Nevertheless, dissection occurs at dimensions below guideline-directed cut-offs for prophylactic surgery. Currently, there are no large-scale population imaging data assessing aortic dimensions before dissection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Patients within the National Echo Database of Australia were stratified according to absolute, height-indexed, and body surface area (BSA)-indexed aortic dimensions. Fatal thoracic aortic dissections (ICD-10-AM Code I71) were identified via linkage with the National Death Index. A total of 524 994 individuals were assessed, comprising patients with normal aortic dimensions (n = 460 992), mild dilation (n = 53 402), moderate dilation (n = 10 029), and severe dilation (n = 572). A total of 274 992 (52.4%) were males, with a median age of 64 years and a median follow-up time of 6.9 years. Eight hundred and ninety-nine fatal aortic dissections occurred (normal diameter = 610, mildly dilated aorta = 215, moderately dilated = 53, and severely dilated = 21). Using normal aortas as the reference population, odds of fatal dissection increased with aortic diameter [mild = odds ratio (OR) 3.05, 95% confidence interval (CI) 2.61\u20133.56; moderate = OR 4.0, 95% CI 3.02\u20135.30; severe = OR 28.72, 95% CI 18.44\u201344.72]. Due to the much larger number of patients without severe aortic dilation, 97.7% of fatal aortic dissections occurred in non-severely dilated aortas. Following sensitivity analysis, severe aortic dilation was responsible for at most 24.4% of fatal aortic dissections. The results were robust for absolute, height-indexed, or BSA-indexed aortic measurements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although severe aortic dilatation is associated with a near-30-fold increase in fatal dissections, severely dilated aortas are implicated in only 2.3\u201324.4% of fatal dissections. This highlights the \u2018aortic paradox\u2019 and limitations of current guidelines. Future studies should seek to refine risk predictors in patients without severe aortic dilation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjci\/jeae140","type":"journal-article","created":{"date-parts":[[2024,5,28]],"date-time":"2024-05-28T19:00:58Z","timestamp":1716922858000},"page":"1423-1431","source":"Crossref","is-referenced-by-count":25,"title":["The aortic paradox: a nationwide analysis of 523 994 individual echocardiograms exploring fatal aortic dissection"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2122-9889","authenticated-orcid":false,"given":"Elizabeth D","family":"Paratz","sequence":"first","affiliation":[{"name":"Heart, Exercise & Research Trials, Victor Chang Cardiac Research Institute , 405 Liverpool St, Darlinghurst, NSW 2010 ,","place":["Australia"]},{"name":"Heart, Exercise and Research Trials, St Vincent\u2019s Institute , 9 Princes St, Fitzroy, VIC 3065 ,","place":["Australia"]},{"name":"Faculty of 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Exercise and Research Trials, St Vincent\u2019s Institute , 9 Princes St, Fitzroy, VIC 3065 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3906-3784","authenticated-orcid":false,"given":"Andre","family":"La Gerche","sequence":"additional","affiliation":[{"name":"Heart, Exercise & Research Trials, Victor Chang Cardiac Research Institute , 405 Liverpool St, Darlinghurst, NSW 2010 ,","place":["Australia"]},{"name":"Heart, Exercise and Research Trials, St Vincent\u2019s Institute , 9 Princes St, Fitzroy, VIC 3065 ,","place":["Australia"]},{"name":"Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne , Parkville, VIC 3000 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Prior","sequence":"additional","affiliation":[{"name":"Heart, Exercise and Research Trials, St Vincent\u2019s Institute , 9 Princes St, Fitzroy, VIC 3065 ,","place":["Australia"]},{"name":"Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne , Parkville, VIC 3000 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7640-0439","authenticated-orcid":false,"given":"David","family":"Celermajer","sequence":"additional","affiliation":[{"name":"Heart Research Institute , 7 Eliza St, Newtown, NSW 2042 ,","place":["Australia"]},{"name":"Department of Cardiology, Royal Prince Alfred Hospital , 50 Missenden Rd, Camperdown, NSW 2050 ,","place":["Australia"]},{"name":"Faculty of Medicine, University of Sydney , Camperdown, NSW 2050 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6800-7119","authenticated-orcid":false,"given":"Geoffrey","family":"Strange","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Prince Charles Hospital , Rode Rd, Chermside, QLD 4032 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