The potential role of ECG-gated computed tomography in predicting the progression of ascending aortic dilatation
AbstractBackground. Thoracic aortic aneurysms are associated with a high risk of fatal complications. In most cases, acute dissections develop when the aortic diameter is less than 5.5 cm. Using only the aortic diameter as the determining criterion for surgical indications is insufficient. In this regard, patients with ascending aortic dilatation (45–49 mm) are of clinical interest.
Objective. To evaluate the prognostic significance of morphometric and biomechanical characteristics of the ascending aorta, as determined by ECG-gated computed tomography (CT) aortography in patients with dilatation of the ascending aorta.
Patients and methods. This prospective, single-center cohort study enrolled a total of 100 patients who were divided into three groups: patients with an ascending aortic aneurysm >50 mm (n=42), patients with ascending aortic dilation 45–49 mm (n=29), and normal subjects with a non-dilated ascending aorta <40 mm (n=29). All patients underwent ECG-gated computed tomography (CT) aortography with the calculation of morphometric and biomechanical parameters. The follow-up period was 36 months. The primary endpoints were defined as an increase in the ascending aortic diameter to ≥50 mm and an increase in the thoracic aortic diameter of >3 mm per year. Binary logistic regression was used to identify independent predictors of reaching the primary endpoint.
Results. A significant impairment of the ascending aortic wall’s deformational properties (decreased circumferential strain and increased stiffness) was observed in the dilation zone compared to the non-dilated aorta. During the 36-month follow-up period, 79.3% of patients reached the primary endpoint. No significant differences in biomechanical parameters were observed when comparing the subgroups of patients with dilation progression and those with stable aortic dimensions. The maximum aortic diameter was found to be the sole independent predictor of disease progression (OR 1.54; 95% CI 1.02–2.35; p=0.042). The optimal prognostic threshold for the diameter in the dilation zone was found to be 47.6 mm (sensitivity – 81.8%, specificity – 77.8%). Patients with a diameter >47.6 mm were 3.98 times more likely to experience rapid disease progression than those with a smaller diameter (log-rank test, p=0.0034).
Conclusion. A CT assessment of the biomechanical properties of the aortic wall confirms the presence of structural remodeling of the ascending aorta and may be considered a marker of aortopathy, alongside its diameter. A threshold diameter of 47.6 mm may be regarded as an important morphometric criterion determining the disease’s transition to the phase of active dilation.
Keywords:ascending aorta; aneurysm; dilatation; computed tomography; mechanometry; prognosis
Authors’ contribution. Study conception and design – Saushkin V.V., Sazonova S.I.; data collection and handling – Saushkin V.V., Varlamova Yu.V., Vrublevskii A.V.; processing of the material – Saushkin V.V.; draft manuscript preparation – Saushkin V.V.; manuscript revision – Saushkin V.V., Sazonova S.I., Vrublevskii A.V., Panfilov D.S., Kozlov B.N.
For citation: Saushkin V.V., Varlamova Yu.V., Vrublevsky A.V., Panfilov D.S., Kozlov B.N., Sazonova S.I. The potential role of ECG-gated computed tomography in predicting the progression of ascending aortic dilatation. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2026; 32 (3): 18–26. DOI: https://doi.org/10.33029/1027-6661-2026-32-3-18-26
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