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      Identification of the main determinants of abdominal aorta size: a screening by Pocket Size Imaging Device

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          Abstract

          Background

          Ultrasound exam as a screening test for abdominal aorta (AA) can visualize the aorta in 99% of patients and has a sensitivity and specificity approaching 100% in screening settings for aortic aneurysm. Pocket Size Imaging Device (PSID) has a potential value as a screening tool, because of its possible use in several clinical settings. Our aim was to assess the impact of demographics and cardiovascular (CV) risk factors on AA size by using PSID in an outpatient screening.

          Methods

          Consecutive patients , referring for a CV assessment in a 6 months period, were screened. AA was visualized by subcostal view in longitudinal and transverse plans in order to determine the greatest anterior-posterior diameter. After excluding 5 patients with AA aneurysm, 508 outpatients were enrolled. All patients underwent a sequential assessment including clinical history with collection of CV risk factors, physical examination, PSID exam and standard Doppler echoc exam using a 2.5 transducer with harmonic capability, both by expert ultrasound operators, during the same morning. Standard echocardiography operators were blinded on PSID exam and viceversa.

          Results

          Diagnostic accuracy of AA size by PSID was tested successfully with standard echo machine in a subgroup ( n = 102) (rho = 0.966, p < 0.0001). AA diameter was larger in men than in women and in ≥50 -years old subjects than in those <50 -years old (both p < 0.0001). AA was larger in patients with coronary artery disease (CAD) ( p < 0.0001). By a multivariate model, male sex ( p < 0.0001), age and body mass index (both p < 0.0001), CAD ( p < 0.01) and heart rate ( p = 0.018) were independent predictors of AA size (cumulative R 2 = 0.184, p < 0.0001).

          Conclusion

          PSID is a reliable tool for the screening of determinants of AA size. AA diameter is greater in men and strongly influenced by aging and overweight. CAD may be also associated to increased AA diameter.

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          Most cited references39

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          The Multicentre Aneurysm Screening Study (MASS) into the effect of abdominal aortic aneurysm screening on mortality in men: a randomised controlled trial.

          Ella L. Kim, Mitchell G. Thompson, Jeremy Day … (2002)
          Opposing views have been published on the importance of ultrasound screening for abdominal aortic aneurysms. The Multicentre Aneurysm Screening Study was designed to assess whether or not such screening is beneficial. A population-based sample of men (n=67800) aged 65-74 years was enrolled, and each individual randomly allocated to either receive an invitation for an abdominal ultrasound scan (invited group, n=33839) or not (control group, n=33961). Men in whom abdominal aortic aneurysms (> or =3 cm in diameter) were detected were followed-up with repeat ultrasound scans for a mean of 4.1 years. Surgery was considered on specific criteria (diameter > or =5.5 cm, expansion > or =1 cm per year, symptoms). Mortality data were obtained from the Office of National Statistics, and an intention-to-treat analysis was based on cause of death. Quality of life was assessed with four standardised scales. The primary outcome measure was mortality related to abdominal aortic aneurysm. 27147 of 33839 (80%) men in the invited group accepted the invitation to screening, and 1333 aneurysms were detected. There were 65 aneurysm-related deaths (absolute risk 0.19%) in the invited group, and 113 (0.33%) in the control group (risk reduction 42%, 95% CI 22-58; p=0.0002), with a 53% reduction (95% CI 30-64) in those who attended screening. 30-day mortality was 6% (24 of 414) after elective surgery for an aneurysm, and 37% (30 of 81) after emergency surgery. Our results provide reliable evidence of benefit from screening for abdominal aortic aneurysms.
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            Prevalence of and risk factors for abdominal aortic aneurysms in a population-based study : The Tromsø Study.

            K. Singh (2001)
            In a population-based study of 6,386 men and women aged 25--84 years in Tromsø, Norway, in 1994--1995, the authors assessed the age- and sex-specific distribution of the abdominal aortic diameter and the prevalence of and risk factors for abdominal aortic aneurysm. Renal and infrarenal aortic diameters were measured with ultrasound. The mean infrarenal aortic diameter increased with age. The increase was more pronounced in men than in women. The age-related increase in the median diameter was less than that in the mean diameter. An aneurysm was present in 263 (8.9%) men and 74 (2.2%) women (p < 0.001). The prevalence of abdominal aortic aneurysm increased with age. No person aged less than 48 years was found with an abdominal aortic aneurysm. Persons who had smoked for more than 40 years had an odds ratio of 8.0 for abdominal aortic aneurysm (95% confidence interval: 5.0, 12.6) compared with never smokers. Low serum high density lipoprotein cholesterol was associated with an increased risk for abdominal aortic aneurysm. Other factors associated with abdominal aortic aneurysm were a high level of plasma fibrinogen and a low blood platelet count. Antihypertensive medication (ever use) was significantly associated with abdominal aortic aneurysm, but high systolic blood pressure was a risk factor in women only. This study indicates that risk factors for atherosclerosis are also associated with increased risk for abdominal aortic aneurysm.
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              Rupture rate of large abdominal aortic aneurysms in patients refusing or unfit for elective repair.

              Jimmy D. Ballard, Frank A Lederle, Katherine W Jordan … (2002)
              Among patients with abdominal aortic aneurysm (AAA) who have high operative risk, repair is usually deferred until the AAA reaches a diameter at which rupture risk is thought to outweigh operative risk, but few data exist on rupture risk of large AAA. To determine the incidence of rupture in patients with large AAA. Prospective cohort study in 47 Veterans Affairs medical centers. Veterans (n = 198) with AAA of at least 5.5 cm for whom elective AAA repair was not planned because of medical contraindication or patient refusal. Patients were enrolled between April 1995 and April 2000 and followed up through July 2000 (mean, 1.52 years). Incidence of AAA rupture by strata of initial and attained diameter. Outcome ascertainment was complete for all patients. There were 112 deaths (57%) and the autopsy rate was 46%. Forty-five patients had probable AAA rupture. The 1-year incidence of probable rupture by initial AAA diameter was 9.4% for AAA of 5.5 to 5.9 cm, 10.2% for AAA of 6.0 to 6.9 cm (19.1% for the subgroup of 6.5-6.9 cm), and 32.5% for AAA of 7.0 cm or more. Much of the increased risk of rupture associated with initial AAA diameters of 6.5-7.9 cm was related to the likelihood that the AAA diameter would reach 8.0 cm during follow-up, after which 25.7% ruptured within 6 months. The rupture rate is substantial in high-operative-risk patients with AAA of at least 5.5 cm in diameter and increases with larger diameter.
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                Author and article information

                Contributors
                Roberta Esposito: robyeire@tin.it
                Federica Ilardi: fedeilardi@gmail.com
                Vincenzo Schiano Lomoriello: capatost@libero.it
                Regina Sorrentino: rejinasorrentino@gmail.com
                Vincenzo Sellitto: sell.vincenzo88@gmail.com
                Giuseppe Giugliano: giuseppe.giugliano@unina.it
                Giovanni Esposito: espogiov@me.com
                Bruno Trimarco: trimarco@unina.it
                Maurizio Galderisi: +39-81-7464749 , mgalderi@unina.it
                Journal
                Journal ID (nlm-ta): Cardiovasc Ultrasound
                Journal ID (iso-abbrev): Cardiovasc Ultrasound
                Title: Cardiovascular Ultrasound
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1476-7120
                Publication date (Electronic): 13 January 2017
                Publication date PMC-release: 13 January 2017
                Publication date Collection: 2017
                Volume: 15
                Electronic Location Identifier: 2
                Affiliations
                [1 ]Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University Hospital, Naples, Italy
                [2 ]Interdepartimental Laboratory of Cardiac Imaging, Federico II University Hospital, Via S. Pansini 5,bld 1, 80131 Naples, Italy
                Article
                Publisher ID: 94
                DOI: 10.1186/s12947-016-0094-z
                PMC ID: 5237342
                PubMed ID: 28086907
                SO-VID: 4b15687e-39f7-4f19-8d4b-3e8c345bd70c
                Copyright © © The Author(s). 2017
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 27 September 2016
                Date accepted : 28 December 2016
                Funding
                Funded by: NA
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © The Author(s) 2017

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: abdominal aorta,pocket size imaging device,ultrasound,aging,cardiovascular risk factors,coronary artery disease
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: abdominal aorta, pocket size imaging device, ultrasound, aging, cardiovascular risk factors, coronary artery disease

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