{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T13:57:30Z","timestamp":1775138250484,"version":"3.50.1"},"reference-count":32,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,18]],"date-time":"2023-01-18T00:00:00Z","timestamp":1674000000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Both relevant aortic valve stenosis (AS) and aortic valve insufficiency significantly contribute to structural changes in the ascending aorta (AA) and thus to its dilatation. In patients with severe AS undergoing transcatheter aortic valve replacement (TAVR), survival data regarding aortic changes and laboratory biomarker analyses are scarce. Methods: A total of 179 patients with severe AS and an available computed tomography were included in this retrospective study. AA was measured, and dilatation was defined as a diameter \u2265 40 mm. Thirty-two patients had dilatation of the AA. A further 32 patients from the present population with a normal AA were matched to the aortic dilatation group with respect to gender, age, body mass index and body surface area, and the resulting study groups were compared with each other. In addition to echocardiographic and clinical characteristics, the expression of cardiovascular biomarkers such as brain natriuretic peptide (BNP), soluble suppression of tumorigenicity-2 (sST2), growth\/differentiation of factor-15 (GDF-15), heart-type fatty-acid binding protein (H-FABP), insulin-like growth factor binding protein 2 (IGF-BP2) and soluble urokinase-type plasminogen activator receptor (suPAR) was analyzed. Kaplan\u2013Meier curves for short- and long-term survival were obtained, and Pearson\u2019s and Spearman\u2019s correlations were calculated to identify the predictors between the diameter of the AA and clinical parameters. Results: A total of 19% of the total cohort had dilatation of the AA. The study group with an AA diameter \u2265 40 mm showed a significantly low comorbidity with respect to diabetes mellitus in contrast to the comparison cohort with an AA diameter &lt; 40 mm (p = 0.010). This result continued in the correlation analyses performed, as the presence of diabetes mellitus correlated negatively not only with the diameter of the AA (r = \u22120.404; p = 0.001) but also with the presence of aortic dilatation (r = \u22120.320; p = 0.010). In addition, the presence of AA dilatation after TAVR was shown to have no differences in terms of patient survival at 1, 3 and 5 years. There were no relevant differences in the cardiovascular biomarkers studied between the patients with dilated and normal AAs. Conclusion: The presence of AA dilatation before successful TAVR was not associated with a survival disadvantage at the respective follow-up intervals of 1, 3 and 5 years. Diabetes mellitus in general seemed to have a protective effect against the development of AA dilatation or aneurysm in patients with severe AS.<\/jats:p>","DOI":"10.3390\/diagnostics13030358","type":"journal-article","created":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T03:45:16Z","timestamp":1674099916000},"page":"358","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["The Presence of Ascending Aortic Dilatation in Patients Undergoing Transcatheter Aortic Valve Replacement Is Negatively Correlated with the Presence of Diabetes Mellitus and Does Not Impair Post-Procedural Outcomes"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6589-3853","authenticated-orcid":false,"given":"Elke","family":"Boxhammer","sequence":"first","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2405-2350","authenticated-orcid":false,"given":"Stefan","family":"Hecht","sequence":"additional","affiliation":[{"name":"Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Reinhard","family":"Kaufmann","sequence":"additional","affiliation":[{"name":"Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00fcrgen","family":"Kammler","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, 4020 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J\u00f6rg","family":"Kellermair","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, 4020 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Reiter","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, 4020 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7100-0268","authenticated-orcid":false,"given":"Kaveh","family":"Akbari","sequence":"additional","affiliation":[{"name":"Department of Radiology, Johannes Kepler University Hospital Linz, 4020 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hermann","family":"Blessberger","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, 4020 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clemens","family":"Steinwender","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kepler University Hospital, Medical Faculty of the Johannes Kepler University Linz, 4020 Linz, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Lichtenauer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uta C.","family":"Hoppe","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Klaus","family":"Hergan","sequence":"additional","affiliation":[{"name":"Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernhard","family":"Scharinger","sequence":"additional","affiliation":[{"name":"Department of Radiology, Paracelsus Medical University of Salzburg, 5020 Salzburg, Austria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1136\/hrt.2008.152751","article-title":"Diseases of the aorta: Aneurysm of the ascending aorta","volume":"96","author":"Evangelista","year":"2010","journal-title":"Heart Br. Card. Soc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1016\/j.amjcard.2013.01.306","article-title":"Distribution, determinants, and normal reference values of thoracic and abdominal aortic diameters by computed tomography (from the Framingham Heart Study)","volume":"111","author":"Rogers","year":"2013","journal-title":"Am. J. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1093\/ehjci\/jex176","article-title":"Ascending aorta dilatation rates in patients with tricuspid and bicuspid aortic stenosis: The COFRASA\/GENERAC study","volume":"19","author":"Kerneis","year":"2018","journal-title":"Eur. Heart J. Cardiovasc. Imaging"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/1749-8090-1-7","article-title":"Post-stenotic aortic dilatation","volume":"1","author":"Wilton","year":"2006","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1161\/ATVBAHA.120.315739","article-title":"Aortic Regurgitation Is Associated With Ascending Aortic Remodeling in the Nondilated Aorta","volume":"41","author":"Balint","year":"2021","journal-title":"Arterioscler. Thromb. Vasc. Biol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.pcad.2021.11.003","article-title":"Transcatheter aortic valve replacement (TAVR): Recent updates","volume":"69","author":"Avvedimento","year":"2021","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1016\/j.amjcard.2020.05.026","article-title":"Long-term Fate of Dilated Ascending Aorta after Aortic Valve Replacement for Bicuspid Versus Tricuspid Aortic Valve Disease","volume":"129","author":"Kim","year":"2020","journal-title":"Am. J. Cardiol."},{"key":"ref_8","first-page":"1422","article-title":"TAVI in 2015: Who, where and how?","volume":"101","author":"Ruparelia","year":"2015","journal-title":"Heart Br. Card. Soc."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"951","DOI":"10.3389\/fimmu.2020.00951","article-title":"Growth\/Differentiation Factor-15 (GDF-15): From Biomarker to Novel Targetable Immune Checkpoint","volume":"11","author":"Wischhusen","year":"2020","journal-title":"Front. Immunol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1488","DOI":"10.1002\/ehf2.12728","article-title":"Growth differentiation factor 15 in adverse cardiac remodelling: From biomarker to causal player","volume":"7","author":"Wesseling","year":"2020","journal-title":"ESC Heart Fail."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"FSO406","DOI":"10.2144\/fsoa-2019-0029","article-title":"Relationship of growth differentiation factor-15 with aortic stiffness in essential hypertension","volume":"5","author":"Sivri","year":"2019","journal-title":"Future Sci. OA"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e14215","DOI":"10.1097\/MD.0000000000014215","article-title":"Association between the level of serum soluble ST2 and invasively measured aortic pulse pressure in patients undergoing coronary angiography","volume":"98","author":"Kim","year":"2019","journal-title":"Medicine"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"697837","DOI":"10.3389\/fcvm.2021.697837","article-title":"Diagnostic Value of sST2 in Cardiovascular Diseases: A Systematic Review and Meta-Analysis","volume":"8","author":"Zhang","year":"2021","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1159\/000446652","article-title":"Increment of HFABP Level in Coronary Artery In-Stent Restenosis Segments in Diabetic and Nondiabetic Minipigs: HFABP Overexpression Promotes Multiple Pathway-Related Inflammation, Growth and Migration in Human Vascular Smooth Muscle Cells","volume":"53","author":"Chen","year":"2016","journal-title":"J. Vasc. Res."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1038\/sj.jhh.1002195","article-title":"Predictive value of heart-type fatty acid-binding protein for left ventricular remodelling and clinical outcome of hypertensive patients with mild-to-moderate aortic valve diseases","volume":"21","author":"Iida","year":"2007","journal-title":"J. Hum. Hypertens."},{"key":"ref_16","first-page":"H499","article-title":"Interaction of angiotensin II and the insulin-like growth factor system in vascular smooth muscle cells","volume":"277","author":"Gustafsson","year":"1999","journal-title":"Am. J. Physiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.ijcard.2018.09.091","article-title":"Insulin like growth factor binding protein 2 (IGFBP-2) for risk prediction in patients with severe aortic stenosis undergoing Transcatheter Aortic Valve Implantation (TAVI)","volume":"277","author":"Muessig","year":"2019","journal-title":"Int. J. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1155\/2009\/504294","article-title":"suPAR: The molecular crystal ball","volume":"27","author":"Macho","year":"2009","journal-title":"Dis. Mark."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1161\/01.RES.0000061571.49375.E1","article-title":"Urokinase-type plasminogen activator plays a critical role in angiotensin II-induced abdominal aortic aneurysm","volume":"92","author":"Deng","year":"2003","journal-title":"Circ. Res."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s00408-019-00211-w","article-title":"Soluble Urokinase-Type Plasminogen Activator Receptor and Arterial Stiffness in Patients with COPD","volume":"197","author":"Losonczy","year":"2019","journal-title":"Lung"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1016\/S0002-9149(01)01530-2","article-title":"Prevalence of aortic root dilatation and small aortic roots in valvular aortic stenosis","volume":"87","author":"Crawford","year":"2001","journal-title":"Am. J. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1093\/ejcts\/ezt123","article-title":"Is there any difference in aortic wall quality between patients with aortic stenosis and those with regurgitation?","volume":"44","author":"Benedik","year":"2013","journal-title":"Eur. J. Cardio-Thorac. Surg. Off. J. Eur. Assoc. Cardio-Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1007\/s10554-011-9956-5","article-title":"Measurement of the ascending aorta diameter in patients with severe bicuspid and tricuspid aortic valve stenosis using dual-source computed tomography coronary angiography","volume":"27","author":"Son","year":"2011","journal-title":"Int. J. Cardiovasc. Imaging"},{"key":"ref_24","first-page":"278","article-title":"Impact of Ascending Aorta Dilation on Mid-Term Outcome After Transcatheter Aortic Valve Implantation","volume":"31","author":"Ancona","year":"2019","journal-title":"J. Invasive Cardiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/j.jtcvs.2012.11.004","article-title":"Long-term prognosis of ascending aortic aneurysm after aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis","volume":"147","author":"Girdauskas","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1093\/ejcts\/ezt594","article-title":"Transcatheter aortic valve implantation in patients with ascending aortic dilatation: Safety of the procedure and mid-term follow-up","volume":"46","author":"Rylski","year":"2014","journal-title":"Eur. J. Cardio-Thorac. Surg. Off. J. Eur. Assoc. Cardio-Thorac. Surg."},{"key":"ref_27","first-page":"E234","article-title":"Progression of the Ascending Aortic Diameter After Transcatheter Aortic Valve Implantation: Based on Computed Tomography Images","volume":"31","author":"Lv","year":"2019","journal-title":"J. Invasive Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"197","DOI":"10.5847\/wjem.j.1920-8642.2019.04.001","article-title":"Ascending aortic dilatation rate after transcatheter aortic valve replacement in patients with bicuspid and tricuspid aortic stenosis: A multidetector computed tomography follow-up study","volume":"10","author":"He","year":"2019","journal-title":"World J. Emerg. Med."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e007618","DOI":"10.1161\/JAHA.117.007618","article-title":"Reduced Long-Term Risk of Aortic Aneurysm and Aortic Dissection Among Individuals with Type 2 Diabetes Mellitus: A Nationwide Observational Study","volume":"7","author":"Avdic","year":"2018","journal-title":"J. Am. Heart Assoc."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1093\/eurheartj\/ehm557","article-title":"Reduced expansion rate of abdominal aortic aneurysms in patients with diabetes may be related to aberrant monocyte-matrix interactions","volume":"29","author":"Golledge","year":"2008","journal-title":"Eur. Heart J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.surg.2010.05.014","article-title":"Hyperglycemia modulates plasminogen activator inhibitor-1 expression and aortic diameter in experimental aortic aneurysm disease","volume":"148","author":"Dua","year":"2010","journal-title":"Surgery"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1159\/000142944","article-title":"Diabetes mellitus: Is it protective against aortic root dilatation?","volume":"112","author":"Chen","year":"2009","journal-title":"Cardiology"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/3\/358\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:09:30Z","timestamp":1760119770000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/13\/3\/358"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,18]]},"references-count":32,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["diagnostics13030358"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics13030358","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,18]]}}}