The relationship between famine exposure during early life and ascending aorta dilatation in adults

Background and aims: The relationship between exposure to famine in early life and the risk of ascending aorta dilatation (AAD) in adulthood is still unclear, therefore we aimed to examine the association in a Chinese population. Methods and results: We investigated the data of 2,598 adults that were born between 1,952 and 1,964 in Guangdong, China. All enrolled subjects were categorized into five groups: not exposed to famine, exposed during fetal period, and exposed during early, mid or late childhood. AAD was assessed by cardiac ultrasound. Multivariate logistic regression and interaction tests were performed to estimate the odds ratio (OR) and confidence interval (CI) on the association between famine exposure and AAD. There were 2,598 (943 male, mean age 58.3 ± 3.68 years) participants were enrolled, and 270 (10.4%) subjects with AAD. We found that famine exposure (OR=2.266, 95% CI: 1.477, 3.477, P=0.013) associated with elevated AAD after adjusting for multiple confounders. In addition, compared with the non-exposure group, the adjusted ORs for famine exposure during fetal period, early, mid or late childhood were 1.374 (95% CI: 0.794, 2.364, P=0.251), 1.976 (95% CI: 1.243, 3.181, P=0.004), 1.929 (95% CI: 1.237, 3.058, P=0.004) and 2.227 (95% CI: 1.433, 3.524, P<0.001), respectively. Subgroup analysis showed that the effect of famine exposure on the association with AAD was more pronounced in female, current smokers, people with BMI ≥24 kg/m2 and hypertensive patients. Conclusion: We observed that exposure to famine during early life was linked to AAD in adulthood.

Progression and Outcomes of Non-dysfunctional Bicuspid Aortic Valve: Longitudinal Data From a Large Korean Bicuspid Aortic Valve Registry

Background: Using echocardiographic surveillance, many patients are diagnosed with bicuspid aortic valve (BAV) without significant valve dysfunction. Limited data are available regarding the progression and outcomes of non-dysfunctional BAV.Methods and Results: We investigated 1,307 BAV patients (984 male, mean age 56 years) diagnosed from Jan 2003 through Dec 2018 in a single tertiary center. Seven hundred sixty-one patients underwent follow-up echocardiography at ≥1 year post-diagnosis. Non-dysfunctional BAV was defined as BAV without moderate aortic stenosis (AS) or aortic regurgitation (AR). The presence of aortopathy was defined as an ascending aorta diameter &gt;37mm. Progression to significant BAV dysfunction, progression to severe aortopathy (ascending aorta diameter ≥45mm), and incidence of valve or aorta operation were analyzed. One hundred eighty-seven (25%) patients showed non-dysfunctional BAV. Among them, 104 (56%) had mild AS or AR, and 81 (43%) had aortopathy at indexed echocardiography. At 6.0 ± 3.8 years post-diagnosis, 56 (29%) progressed to dysfunctional BAV, 28 (15%) progressed to severe aortopathy, 22 (12%) underwent valve operation, and 19 (10%) experienced aorta operation. Eighty-nine percent of patients with normal BAV function and 61% of patients with mild AS or AR maintained non-dysfunctional BAV. More patients with aortopathy progressed to severe aortopathy (35 vs. 0% without aortopathy, p &lt; 0.001), with a higher incidence of aorta operation (21 vs. 2%, p &lt; 0.001).Conclusions: In patients with non-dysfunctional BAV, initial BAV function and degree of aorta dilatation might be important for progression and outcomes. Patients without any dysfunction or aortopathy tend to maintain good structure and function for 6 years.

Primary and secondary aortopathy associated with adult congenital heart disease - retrospective study

Background Primary and secondary aortopathy are frequently encountered in patients with congenital heart disease. The aim of this study is to present our experience and the incidence of primary and secondary adult CHD-associated aortopathy. Methods The cohort is comprised of adult patients with congenital heart disease from the registry of the Eastern Slovakia Institute of Cardiovascular Diseases. Data from the last follow-up examinations are included in this study. In the primary and secondary aortopathy groups were 35 and 12 patients respectively. As a control group were selected 64 patients with non aortopathy associated congenital heart disease (atrial and ventricular septal defect). Results Patients with primary and secondary aortopathy had larger ascending aorta/aortic root diameters than the control group (36.28 (26–49) mm vs 30.25 (21–41) mm p = 0.000113, 33.82 27–49) mm vs 29.03 (19–38)mm p = 0.000366 and 42.1 (30–50) mm vs 30.25 (21–41) mm, p = 0.000106, 35.67 (27–48) mm vs 29.03 (19–38) mm, p = 0.000119 respectively). Moreover, patients with secondary aortopathy had statistically significant larger ascending aorta diameter compared to the patients with primary aortopathy (42.1 (30–50) mm vs 36.28 (26–49) mm p = 0.030). During the follow-up period, were performed only in 2 patients (one from each group) operations on the aortic root and the ascending aorta due to aortic root or ascending aorta dilatation. Conclusion More patients with secondary aortopathy had dilated ascending aorta/ aortic root, as well as larger aortic diameters compare to the patients with primary aortopathy. Routine follow-up of these patients with attention to aortic diameter is necessary.

Primary and secondary aortopathy associated with adult congenital heart disease - retrospective study

Background: Primary and secondary aortopathy are frequently encountered in patients with congenital heart disease. The aim of this study is to present our experience and the incidence of primary and secondary adult CHD-associated aortopathy.Methods. The cohort is comprised of adult patients with congenital heart disease from the registry of the Eastern Slovakia Institute of Cardiovascular Diseases. Data from the last follow-up examinations are included in this study. In the primary and secondary aortopathy groups were 35 and 12 patients respectively. As a control group were selected 64 patients with non aortopathy associated congenital heart disease (atrial and ventricular septal defect).Results: Patients with primary and secondary aortopathy had larger ascending aorta/aortic root diameters than the control group (36.28 (26-49) mm vs 30.25 (21-41) mm p=0.000113, 33.82 27-49) mm vs 29.03 (19-38)mm p=0.000366 and 42.1 (30-50) mm vs 30.25 (21-41) mm, p=0.000106, 35.67 (27-48) mm vs 29.03 (19-38) mm, p=0.000119 respectively). Moreover, patients with secondary aortopathy had statistically significant larger ascending aorta diameter compared to the patients with primary aortopathy ( 42.1 (30-50) mm vs 36.28 ( 26-49) mm p=0.030). During the follow-up period, were performed only in 2 patients (one from each group) operations on the aortic root and the ascending aorta due to aortic root or ascending aorta dilatation.Conclusion: More patients with secondary aortopathy had dilated ascending aorta/ aortic root, as well as larger aortic diameters compare to the patients with primary aortopathy. Routine follow-up of these patients with attention to aortic diameter is necessary.

Famine Exposure During Early Life Increased the Risk of Ascending Aorta Dilatation in Adults

Background: The relationship between malnutrition and ascending aorta dilatation (AAD) is still unclear. Therefore, the aim of this study was to examine the association of exposure to the Chinese famine during early life with AAD in adulthood. Methods: We investigated data of 2598 adults born between 1952 and 1964 from Guangdong, China. All enrolled subjects were divided into five groups: no exposed, fetal exposed, early, mid and late childhood exposed. AAD was assessed by cardiac ultrasound. Multivariate logistic regression and interaction tests were used to estimate the odds ratio (OR) and confidence interval (CI) between famine exposure and AAD. Results: There were 2598 (943 male, mean age 59.1 ± 3.65 years) participants were enrolled, among them consist of 270 (10.4%) subjects with AAD. We found that famine exposure (OR=2.266, 95% CI: 1.477, 3.477, P=0.013), age, smoking, hypertension, elevated SBP, elevated BMI was an independent risk factor for AAD. In addition, compared with no exposed group, the adjusted ORs for AAD widening from fetal-exposed, early, mid to late childhood exposed were 1.374 (95% CI: 0.794, 2.364, P=0.251), 1.976 (95% CI: 1.243, 3.181, P=0.004), 1.929 (95% CI: 1.237, 3.058, P=0.004) and 2.227 (95% CI: 1.433, 3.524, P<0.001), respectively. Stratified analysis showed that the effect of famine exposure on AAD was more pronounced in female, smokers, BMI ≥24 kg/m2 and hypertensive patients. Conclusions: We observed that exposure to famine during early life was an independent risk factor for AAD in adulthood; this effect was not modified by gender, BMI, smoking, hypertension and diabetes.