ArticleJournal of the American Heart Association2026
Growth Trajectories in Ascending Thoracic Aortic Dilation: Classification and Implications for the Effectiveness of Real-World Imaging Surveillance.
Article in Journal of the American Heart Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
backgroundAscending aortic dilation is monitored with serial imaging, yet event rates are low, with type A dissections often occurring at nonsurgical sizes. We aimed to characterize ascending aortic growth trajectories in a real-world population to understand their clinical consequences and better inform surveillance strategies.
methodsWe conducted a retrospective, single-center study of adults with ≥2 thoracic computed tomography angiography/magnetic resonance angiography examinations. Midascending diameters from clinical reports were used to analyze real-world surveillance effectiveness. Growth trajectories were clustered using latent profile analysis. Early (first 3 scans; n=1997) and extended (first 5 scans; n=757) latent profile analysis models each yielded 4 classes: Stable, Growth, Dramatic Growth, and Fluctuation (an unstable trajectory attributed to measurement noise).
resultsWe studied 3363 adults (median age 62 years; 68% men). Stable class was most common (74% Early; 70 % Extended); Growth and Dramatic Growth classes comprised 23% and 2% respectively. Only 1.1% met guideline growth-based criteria for repair, and this subgroup had smaller baseline diameters (37.0 versus 40.3 mm,
conclusionsMost patients with a dilated ascending aorta show negligible growth and low complication rates during routine surveillance. Repeated imaging beyond 3 scans may amplify uncertainty without clear improvements in risk stratification, suggesting that imaging surveillance may be safely deescalated for stable patients.
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