{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T15:09:44Z","timestamp":1785510584364,"version":"3.56.0"},"reference-count":27,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T00:00:00Z","timestamp":1693353600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82200518"],"award-info":[{"award-number":["82200518"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Science and Technology Projects in Guangzhou","award":["2023A04J0490"],"award-info":[{"award-number":["2023A04J0490"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,9,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Large-scale investigations on ascending aortic diameter, especially in the Asian population, are lacking. Furthermore, relevant evidence regarding the distribution of hypertension (HP), bicuspid aortic valve (BAV), and Marfan syndrome (MFS) is scarce. We aimed to examine the distribution of ascending aortic diameter in these populations in China.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>The data of a total number of 698 795 individuals who underwent cardiac ultrasound were subjected to retrospective analysis. After screening, 647 087 individuals were included in the final analysis. In the normal population, the mean ascending aortic diameter was 28.1 \u00b1 3.2\u2005mm (27.2 \u00b1 3.1\u2005mm in women vs. 29.0 \u00b1 3.1\u2005mm in men) (P &amp;lt; 0.001). Aortic diameter increased gradually with age (P &amp;lt; 0.001). The prevalence of aortic dilation, aneurysm, and dissection in individuals with HP was 12.83%, 2.70%, and 4.77%, respectively. In individuals with MFS, the corresponding rates were 43.92%, 35.31%, and 26.11%. Notably, although BAV patients had high incidences of aortic dilation (37.00%) and aortic aneurysm (16.46%), the incidence of aortic dissection was relatively low (0.74%). Most cases of aortic dissection occurred at an aortic diameter of less than 55\u2005mm. However, in the overall population, the incidence of aortic dissection significantly increased with the increase in the aortic diameter, revealing the existence of an \u2018aortic paradox\u2019.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>(i) The ascending diameter increases with age and is larger in men than in women; (ii) \u2018Aortic paradox\u2019 is explained; (iii) BAV bears a high rate of aortic dilation, but a low incidence of aortic dissection.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjimp\/qyad019","type":"journal-article","created":{"date-parts":[[2023,8,30]],"date-time":"2023-08-30T15:51:20Z","timestamp":1693410680000},"source":"Crossref","is-referenced-by-count":8,"title":["Aortic size distribution among normal, hypertension, bicuspid, and Marfan populations"],"prefix":"10.1093","volume":"1","author":[{"given":"Jinlin","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People\u2019s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University , Guangzhou 510080 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiyue","family":"Zeng","sequence":"additional","affiliation":[{"name":"Department of Emergency, Guangdong Provincial People\u2019s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University , Zhongshan 2nd Rd 106, Guangzhou 510080 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoshan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Echocardiography, Guangdong Provincial People\u2019s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University , Zhongshan 2nd Rd 106, Guangzhou 510080 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiade","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People\u2019s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University , Guangzhou 510080 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chenyu","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Fuwai Hospital , Beijing 100037 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruixin","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People\u2019s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University , Guangzhou 510080 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tucheng","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People\u2019s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University , Guangzhou 510080 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3731-2668","authenticated-orcid":false,"given":"Hongwen","family":"Fei","sequence":"additional","affiliation":[{"name":"Department of Echocardiography, Guangdong Provincial People\u2019s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University , Zhongshan 2nd Rd 106, Guangzhou 510080 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Emergency, Guangdong Provincial People\u2019s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University , Zhongshan 2nd Rd 106, Guangzhou 510080 , China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,8,30]]},"reference":[{"key":"2024010307190556200_qyad019-B1","doi-asserted-by":"crossref","first-page":"11","DOI":"10.12945\/j.aorta.2017.17.003","article-title":"Genes associated with thoracic aortic aneurysm and dissection: an update and clinical implications","volume":"5","author":"Brownstein","year":"2017","journal-title":"Aorta (Stamford)"},{"key":"2024010307190556200_qyad019-B2","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1016\/j.jacc.2019.07.078","article-title":"Ascending aortic length and risk of aortic adverse events: the neglected dimension","volume":"74","author":"Wu","year":"2019","journal-title":"J Am Coll Cardiol"},{"key":"2024010307190556200_qyad019-B3","doi-asserted-by":"crossref","first-page":"1935","DOI":"10.1001\/jama.2022.19701","article-title":"Development of a prediction model for ascending aortic diameter among asymptomatic individuals","volume":"328","author":"Pirruccello","year":"2022","journal-title":"JAMA"},{"key":"2024010307190556200_qyad019-B4","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"335","author":"Erik","year":"2007","journal-title":"BMJ"},{"key":"2024010307190556200_qyad019-B5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2014.10.003","article-title":"Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging","volume":"28","author":"Lang","year":"2015","journal-title":"J Am Soc Echocardiogr"},{"key":"2024010307190556200_qyad019-B6","doi-asserted-by":"crossref","first-page":"e334","DOI":"10.1161\/CIR.0000000000001106","article-title":"2022 ACC\/AHA guideline for the diagnosis and management of aortic disease: a report of the American Heart Association\/American College of Cardiology Joint Committee on Clinical Practice Guidelines","volume":"146","author":"Isselbacher","year":"2022","journal-title":"Circulation"},{"key":"2024010307190556200_qyad019-B7","doi-asserted-by":"crossref","first-page":"1938","DOI":"10.1016\/j.jtcvs.2017.10.140","article-title":"Height alone, rather than body surface area, suffices for risk estimation in ascending aortic aneurysm","volume":"155","author":"Zafar","year":"2018","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024010307190556200_qyad019-B8","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1016\/j.acra.2008.02.001","article-title":"Normal thoracic aorta diameter on cardiac computed tomography in healthy asymptomatic adults: impact of age and gender","volume":"15","author":"Mao","year":"2008","journal-title":"Acad Radiol"},{"key":"2024010307190556200_qyad019-B9","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/j.amjcard.2014.06.024","article-title":"Reference values for echocardiographic assessment of the diameter of the aortic root and ascending aorta spanning all age categories","volume":"114","author":"Campens","year":"2014","journal-title":"Am J Cardiol"},{"key":"2024010307190556200_qyad019-B10","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1007\/s10554-020-02116-9","article-title":"Reference values of thoracic aorta and pulmonary artery diameters by age and gender in healthy Chinese adults assessed by cardiac magnetic resonance imaging: data from National Center for Cardiovascular Diseases of China","volume":"37","author":"Li","year":"2021","journal-title":"Int J Cardiovasc Imaging"},{"key":"2024010307190556200_qyad019-B11","doi-asserted-by":"crossref","first-page":"105","DOI":"10.3348\/jksr.2013.69.2.105","article-title":"Measurement of the aortic diameter in the asymptomatic Korean population: assessment with multidetector CT","volume":"69","author":"Lee","year":"2013","journal-title":"J Korean Soc Radiol"},{"key":"2024010307190556200_qyad019-B12","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.jcmg.2007.11.005","article-title":"Aortic size assessment by noncontrast cardiac computed tomography: normal limits by age, gender, and body surface area","volume":"1","author":"Wolak","year":"2008","journal-title":"JACC Cardiovasc Imaging"},{"key":"2024010307190556200_qyad019-B13","doi-asserted-by":"crossref","first-page":"1068","DOI":"10.1016\/j.amjcard.2018.06.006","article-title":"Reference values for mid-ascending aorta diameters by transthoracic echocardiography in adults","volume":"122","author":"Ayoub","year":"2018","journal-title":"Am J Cardiol"},{"key":"2024010307190556200_qyad019-B14","doi-asserted-by":"crossref","first-page":"2995","DOI":"10.1016\/j.jtcvs.2014.07.068","article-title":"Clinical features of acute aortic dissection from the registry of aortic dissection in China","volume":"148","author":"Wang","year":"2014","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024010307190556200_qyad019-B15","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.athoracsur.2020.08.026","article-title":"Increased virulence of descending thoracic and thoracoabdominal aortic aneurysms in women","volume":"112","author":"Chen","year":"2021","journal-title":"Ann Thorac Surg"},{"key":"2024010307190556200_qyad019-B16","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/S0022-5223(97)70360-X","article-title":"What is the appropriate size criterion for resection of thoracic aortic aneurysms?","volume":"113","author":"Coady","year":"1997","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2024010307190556200_qyad019-B17","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/S0003-4975(01)03236-2","article-title":"Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size","volume":"73","author":"Davies","year":"2002","journal-title":"Ann Thorac Surg"},{"key":"2024010307190556200_qyad019-B18","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1016\/j.athoracsur.2006.10.074","article-title":"Natural history of ascending aortic aneurysms in the setting of an unreplaced bicuspid aortic valve","volume":"83","author":"Davies","year":"2007","journal-title":"Ann Thorac Surg"},{"key":"2024010307190556200_qyad019-B19","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1093\/eurheartj\/ehu281","article-title":"2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC)","volume":"35","author":"Erbel","year":"2014","journal-title":"Eur Heart J"},{"key":"2024010307190556200_qyad019-B20","doi-asserted-by":"crossref","first-page":"1120","DOI":"10.1161\/CIRCULATIONAHA.107.702720","article-title":"Aortic diameter &gt; or = 5.5 cm is not a good predictor of type A aortic dissection: observations from the international registry of acute aortic dissection (IRAD)","volume":"116","author":"Pape","year":"2007","journal-title":"Circulation"},{"key":"2024010307190556200_qyad019-B21","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":"Paruchuri","year":"2015","journal-title":"Cardiology"},{"key":"2024010307190556200_qyad019-B22","doi-asserted-by":"crossref","first-page":"1094","DOI":"10.1016\/j.amjcard.2006.05.032","article-title":"Comparison of the pattern of aortic dilation in children with the Marfan\u2019s syndrome versus children with a bicuspid aortic valve","volume":"98","author":"Beroukhim","year":"2006","journal-title":"Am J Cardiol"},{"key":"2024010307190556200_qyad019-B23","doi-asserted-by":"crossref","first-page":"S1773","DOI":"10.1016\/S0003-4975(02)04261-3","article-title":"Aortic complications after bicuspid aortic valve replacement: long-term results","volume":"74","author":"Russo","year":"2002","journal-title":"Ann Thorac Surg"},{"key":"2024010307190556200_qyad019-B24","doi-asserted-by":"crossref","first-page":"e84","DOI":"10.1161\/CIRCULATIONAHA.106.176857","article-title":"ACC\/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1998 guidelines for the management of patients with valvular heart disease): developed in collaboration with the Society of Cardiovascular Anesthesiologists: endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons","volume":"114","author":"Bonow","year":"2006","journal-title":"Circulation"},{"key":"2024010307190556200_qyad019-B25","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1001\/jama.2020.27205","article-title":"Prevalence of bicuspid aortic valve and associated aortopathy in newborns in Copenhagen, Denmark","volume":"325","author":"Sillesen","year":"2021","journal-title":"JAMA"},{"key":"2024010307190556200_qyad019-B26","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1016\/j.ijcard.2015.08.106","article-title":"Bicuspid aortic valve aortopathy in adults: incidence, etiology, and clinical significance","volume":"201","author":"Michelena","year":"2015","journal-title":"Int J Cardiol"},{"key":"2024010307190556200_qyad019-B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2023.04.017","article-title":"Bicuspid aortopathy does not require earlier surgical intervention","author":"Zafar","year":"2023","journal-title":"J Thorac Cardiovasc Surg"}],"container-title":["European Heart Journal - Imaging Methods and Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjimp\/advance-article-pdf\/doi\/10.1093\/ehjimp\/qyad019\/51306189\/qyad019.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjimp\/article-pdf\/1\/2\/qyad019\/54932219\/qyad019.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjimp\/article-pdf\/1\/2\/qyad019\/54932219\/qyad019.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,3]],"date-time":"2024-01-03T07:19:30Z","timestamp":1704266370000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjimp\/article\/doi\/10.1093\/ehjimp\/qyad019\/7255521"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,30]]},"references-count":27,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,9,8]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjimp\/qyad019","relation":{},"ISSN":["2755-9637"],"issn-type":[{"value":"2755-9637","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,9]]},"published":{"date-parts":[[2023,8,30]]},"article-number":"qyad019"}}