{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T10:39:04Z","timestamp":1785494344301,"version":"3.56.0"},"reference-count":25,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"unspecified","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2026,1,12]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Aortic dimensions are critical for assessing the risk of acute aortic complications and guiding surgical interventions. Current guidelines define absolute diameter thresholds based largely on Western cohorts, while data on Indian patients remain limited. To address this gap, our study provides a direct, large-scale comparison of aortic diameters between Indian and Dutch individuals to determine whether existing geometry-based surgical guidelines are equally applicable across populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective cohort study, we analysed all consecutive patients who underwent CT imaging between January and December 2022 at SIMS Hospital (India) and Amsterdam University Medical Center (Netherlands). Aortic diameters were measured at five predefined anatomical locations: aortic root, ascending aorta, aortic arch, descending aorta and abdominal aorta. Multivariable linear regression models were used, adjusting for age, sex, height and comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 3692 patients were included (2000 Indian and 1692 Dutch). Indian patients had a larger aortic root (33.9 \u00b1 4.6\u2009mm vs 31.5 \u00b1 5.4\u2009mm; p&lt;0.001), whereas Dutch patients had significantly larger diameters of the ascending aorta (33.1 \u00b1 5.4\u2009mm vs 30.5 \u00b1 4.3\u2009mm; p&lt;0.001), aortic arch (29.8 \u00b1 4.5\u2009mm vs 26.4 \u00b1 3.7\u2009mm; p&lt;0.001), descending aorta (26.7 \u00b1 4.2\u2009mm vs 23.0 \u00b1 3.9 mm; p&lt;0.001) and abdominal aorta (23.1 \u00b1 5.0\u2009mm vs 21.3 \u00b1 3.4\u2009mm; p&lt;0.001). These differences persisted after adjustment for age, sex, height and comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this first global comparison of ascending aortic dimensions between Indian and Dutch patients, we demonstrate substantial geographic heterogeneity. These findings highlight concerns about applying current surgical thresholds to Indian patients with aortopathy and emphasise the need for individualised risk assessment and treatment strategies in this population. Future guidelines should consider population-specific differences in India and incorporate indexed measurements to optimise personalised surgical decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/openhrt-2025-003808","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T12:35:22Z","timestamp":1769171722000},"page":"e003808","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Ethnic variation in thoracic aortic dimensions in the general population: a comparison between Indian and Dutch populations"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-6926-9890","authenticated-orcid":false,"given":"Nora","family":"Bacour","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5981-9705","authenticated-orcid":false,"given":"Mohammed","family":"Idhrees","sequence":"additional","affiliation":[{"name":"SRM Institutes for Medical Science (SIMS Hospital), Institute of Cardiac and Aortic Disorders (ICAD), Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jedidiah","family":"Samraj","sequence":"additional","affiliation":[{"name":"SRM Institutes for Medical Science (SIMS Hospital), Institute of Cardiac and Aortic Disorders (ICAD), Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simran","family":"Grewal","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bashi","family":"Velayudhan","sequence":"additional","affiliation":[{"name":"SRM Institutes for Medical Science (SIMS Hospital), Institute of Cardiac and Aortic Disorders (ICAD), Chennai, Tamil Nadu, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nafiye","family":"Busra Celik","sequence":"additional","affiliation":[{"name":"Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Zafar","sequence":"additional","affiliation":[{"name":"Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A","family":"Elefteriades","sequence":"additional","affiliation":[{"name":"Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nimrat","family":"Grewal","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Amsterdam University Medical Centres, Amsterdam, The Netherlands"},{"name":"Aortic Institute at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut, USA"},{"name":"Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"2026012304351673000_13.1.e003808.1","doi-asserted-by":"crossref","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":"Czerny","year":"2024","journal-title":"Eur J Cardiothorac Surg"},{"key":"2026012304351673000_13.1.e003808.2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001106"},{"key":"2026012304351673000_13.1.e003808.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(01)03236-2"},{"key":"2026012304351673000_13.1.e003808.4","doi-asserted-by":"publisher","DOI":"10.1159\/000381281"},{"key":"2026012304351673000_13.1.e003808.5","doi-asserted-by":"crossref","unstructured":"Ansari A , Syed K , Baig M , et al . 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