{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T19:34:11Z","timestamp":1790883251934,"version":"4.1.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"24","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,12,16]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Thoracic ascending aortopathy (AA) is often asymptomatic and incidentally diagnosed, with surgical replacement recommended once it becomes aneurysmal. We report sex\u2010based characteristics and long\u2010term outcomes of patients with AA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">This study analyzed 14\u2009244 patients (21.1% women) with unrepaired AA (\u22654\u2009cm) diagnosed via echocardiography from 2010 to 2023, excluding those with acute aortic dissection\/rupture at presentation (n=1179). Baseline data, including height\u2010indexed measurements (ascending aortic area height index and cross\u2010sectional area to height ratio), were collected. AA surgery and rates of aortic dissection\/rupture during follow\u2010up were recorded. Cox proportional hazards and Kaplan\u2013Meier survival analysis were performed for all\u2010cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Women were older (63.6 versus 62.3\u2009years) and had fewer comorbidities, including hypertension, diabetes, coronary artery disease, and dyslipidemia (all\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). However, women had higher height\u2010indexed aortic measurements (ascending aortic area height index: 2.81 versus 2.59\u2009cm\/m; cross\u2010sectional area to height ratio: 10.3 versus 9.5\u2009cm\n                      <jats:sup>2<\/jats:sup>\n                      \/m, both\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001) and fewer aneurysms \u22655\u2009cm (20.6% versus 22.8%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.04). At 0.86\u2009years, 26.1% underwent surgery, with higher rates in women (28.2% versus 25.6%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.002) and low in\u2010hospital mortality (0.9%). Over 6.2\u2009years, women had worse survival (14.2% versus 11.2%, log\u2010rank\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001), with female sex independently associated with higher mortality (hazard ratio [HR], 1.14;\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). Aortic surgery improved survival (HR, 0.81;\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). Among unoperated patients (n=10\u2009523), 62.9% of deaths and 72.4% of dissections\/ruptures occurred in women with aortic diameters &lt;5\u2009cm.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Despite fewer comorbidities and higher surgical rates, women with AA had worse long\u2010term survival. Sex\u2010specific thresholds for AA surgery may warrant consideration.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.045827","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T12:03:02Z","timestamp":1764763382000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Sex\u2010Based Differences in Long\u2010Term Outcomes of Patients With Ascending Aortic Dilation"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-8658-8656","authenticated-orcid":false,"given":"Mohammed","family":"Abusafia","sequence":"first","affiliation":[{"name":"Cleveland Clinic","place":["Cleveland, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6175-4775","authenticated-orcid":false,"given":"Shada","family":"Jadam","sequence":"additional","affiliation":[{"name":"Cleveland Clinic","place":["Cleveland, 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