{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T19:34:13Z","timestamp":1790883253942,"version":"4.1.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2016,11,29]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>In patients with a dilated proximal ascending aorta and trileaflet aortic valve, we aimed to assess (1) factors independently associated with increased long-term mortality and (2) the incremental prognostic utility of indexing aortic root to patient height.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We studied consecutive patients with a dilated aortic root (\u22654 cm) that underwent echocardiography and gated contrast-enhanced thoracic aortic computed tomography or magnetic resonance angiography between 2003 and 2007. A ratio of aortic root area over height was calculated (cm\n                      <jats:sup>2<\/jats:sup>\n                      \/m) on tomography, and a cutoff of 10 cm\n                      <jats:sup>2<\/jats:sup>\n                      \/m was chosen as abnormal, on the basis of previous reports. All-cause death was recorded.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The cohort comprised 771 patients (63 years [interquartile range, 53\u201371], 87% men, 85% hypertension, 51% hyperlipidemia, 56% smokers). Inherited aortopathies, moderate to severe aortic regurgitation, and severe aortic stenosis were seen in 7%, 18%, and 2%, whereas 91% and 54% were on \u03b2-blockers and angiotensin-converting enzyme inhibitors, respectively. Aortic root area\/height ratio was \u226510 cm\n                      <jats:sup>2<\/jats:sup>\n                      \/m in 24%. The Society of Thoracic Surgeons score and right ventricular systolic pressure were 3.3\u00b13 and 31\u00b17 mm\u2009Hg, respectively. At 7.8 years (interquartile range, 6.6\u20138.9), 280 (36%) patients underwent aortic surgery (76% within 1 year) and 130 (17%) died (1% in-hospital postoperative mortality). A lower proportion of patients in the surgical (versus nonsurgical) group died (13% versus 19%,\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.01). On multivariable Cox proportional hazard analysis, aortic root area\/height ratio (hazard ratio, 4.04; 95% confidence interval [CI], 2.69\u20136.231) was associated with death, whereas aortic surgery (hazard ratio, 0.47; 95% CI, 0.27\u20130.81) was associated with improved survival (both\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.01). For longer-term mortality, the addition of aortic root area\/height ratio \u226510 cm\n                      <jats:sup>2<\/jats:sup>\n                      \/m to a clinical model (Society of Thoracic Surgeons score, inherited aortopathies, hypertension, hyperlipidemia, medications, aortic regurgitation, and right ventricular systolic pressure), increased the c-statistic from 0.57 (95% CI, 0.35\u20130.77) to 0.65 (95% CI, 0.52\u20130.73) and net reclassification index from 0.17 (95% CI, 0.02\u20130.31) to 0.23 (95% CI, 0.04\u20130.34), both\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.01. Of the 327 patients with aortic root diameter between 4.5 and 5.5 cm, 44% had an abnormal aortic root area\/height ratio, of which 78% died.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In patients with dilated aortic root and trileaflet aortic valve, a ratio of aortic root area to height provides independent and improved stratification for prediction of death.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.116.022995","type":"journal-article","created":{"date-parts":[[2016,10,21]],"date-time":"2016-10-21T23:45:37Z","timestamp":1477093537000},"page":"1724-1737","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":99,"title":["Aortic Cross-Sectional Area\/Height Ratio and Outcomes in Patients With a Trileaflet Aortic Valve and a Dilated Aorta"],"prefix":"10.1161","volume":"134","author":[{"given":"Ahmad","family":"Masri","sequence":"first","affiliation":[{"name":"From Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vidyasagar","family":"Kalahasti","sequence":"additional","affiliation":[{"name":"From Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars G.","family":"Svensson","sequence":"additional","affiliation":[{"name":"From Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric E.","family":"Roselli","sequence":"additional","affiliation":[{"name":"From Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas","family":"Johnston","sequence":"additional","affiliation":[{"name":"From Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald","family":"Hammer","sequence":"additional","affiliation":[{"name":"From Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Schoenhagen","sequence":"additional","affiliation":[{"name":"From Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian P.","family":"Griffin","sequence":"additional","affiliation":[{"name":"From Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milind Y.","family":"Desai","sequence":"additional","affiliation":[{"name":"From Center for Aortic Disease, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(00)70090-0"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi024"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2004.09.005"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e3181d4739e"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.107.702720"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.91.3.734"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.937839"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-5223(03)00608-1"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1067\/mtc.2002.118497"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2005.06.026"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.04.126"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2012.05.063"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjci\/jev014"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0894-7317(03)00335-3"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2010.05.010"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2008.11.029"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1916.00080130010002"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000029"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2012.12.027"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.015939"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.4154"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1038\/gim.2012.172"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2015.10.113"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2015.08.011"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezu083"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2015.12.019"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(99)00250-8"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCULATIONAHA.116.022995","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,6]],"date-time":"2025-02-06T03:27:49Z","timestamp":1738812469000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCULATIONAHA.116.022995"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,11,29]]},"references-count":27,"journal-issue":{"issue":"22","published-print":{"date-parts":[[2016,11,29]]}},"alternative-id":["10.1161\/CIRCULATIONAHA.116.022995"],"URL":"https:\/\/doi.org\/10.1161\/circulationaha.116.022995","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.726872082.793524667","asserted-by":"object"}]},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,11,29]]},"assertion":[{"value":"2016-04-14","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-09-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2016-10-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}