ORIGINAL ARTICLE   

Italian Journal of Vascular and Endovascular Surgery 2024 June;31(2):84-101

DOI: 10.23736/S1824-4777.24.01655-3

Copyright © 2024 EDIZIONI MINERVA MEDICA

lingua: Inglese

Abdominal aortic aneurysms: is it time for a diagnostic revolution? Evidence from the Cardiovascular Health Study

Fabio ZECCA ¹ ✉, Lorenzo MANNELLI ², Gavino FAA ³, Giuseppe MUSCOGIURI ⁴, Roberto SANFILIPPO ⁵, Jasjit S. SURI ^{6, 7}, Luca SABA ¹

¹ Department of Radiology, University Hospital of Cagliari, Cagliari, Italy; ² IRCCS SYNLAB SDN, Naples, Italy; ³ Department of Pathology, University Hospital of Cagliari, Cagliari, Italy; ⁴ University of Milan-Bicocca, Milan, Italy; ⁵ Department of Vascular Surgery, University Hospital of Cagliari, Cagliari, Italy; ⁶ Stroke Diagnosis and Monitoring Divisions, AtheroPoint™, Roseville, CA, USA; ⁷ Department of Computer Engineering, Idaho State University, Pocatello, ID, USA

BACKGROUND: Standardization of aortometry is needed for overcoming several epidemiological issues concerning the abdominal aortic aneurysm (AAA), yet evidence is lacking. We retrospectively queried the Cardiovascular Health Study (CHS) database to explore the statistic profiles of different aortic size metrics and the influence of diverse diagnostic criteria on AAA prevalence rates.
METHODS: Included subjects underwent an abdominal aortic ultrasound. Suprarenal aortic diameter (DSR), maximal infrarenal aortic diameter (DIRmax), infrarenal-to-suprarenal ratio (IR/SR), and aortic size index (ASI) were measured, and demographic, anthropometric, clinical, and laboratory data were collected. Group comparisons and stepwise multivariable regression analyses were performed. Individual compliance with nine different AAA diagnostic criteria was investigated before and after randomized matching of the sample.
RESULTS: Following the exclusion of incomplete cases, 4493 subjects were included in our analyses, with a median [IQR] DSR of 19.5 [4.4] mm, DIRmax of 19.2 [4.5] mm, IR/SR of 1.00 [0.14], and ASI of 1.07 [0.22]. The aortic size metrics exhibited significantly different distribution patterns influenced by sex, age, body size, smoking history, and several laboratory biomarkers. As diagnostic criteria changed, substantial modifications in AAA prevalence rates were observed.
CONCLUSIONS: Standardized adjustment of aortic size might be of utility for improving diagnostic accuracy for AAA. Integration of clinical data, laboratory results, relative aortic indices, and aortic wall-related parameters obtained via advanced imaging modalities into a multiparametric scoring system could ameliorate AAA-focused research and management.

KEY WORDS: Aorta; Early diagnosis; Epidemiology; Imaging; Reference standards