Ascending aortic diameter predicts aortic dissection better than size index in Turner syndrome

Among women with Turner syndrome (TS), aortic dissection appears to be more correlated with the ascending aortic diameter (AAD) than with aortic size index (ASI), a new study has found. TS-specific z-score is also a reliable predictor of dissection.

Researchers conducted a prospective and observational analysis of 400 women with TS (mean age 27 years), all of whom had undergone echocardiography for the measurement of aortic parameters. On average, participants each had 1.75 available echocardiography reports.

Twelve patients (3 percent) eventually developed aortic dissection. This group tended to be older at enrollment and had higher systolic blood pressure, with wider absolute AAD and ascending ASI.

Receiver operating characteristic curve analysis showed that at a cutoff value of 2.5 cm/m², ascending ASI had a sensitivity of 17 percent for predicting aortic dissection.

In comparison, AAD and TS-specific z-score were much better indicators. At a cutoff value of 3.3 cm, AAD yielded a sensitivity of 92 percent. Similarly, TS-specific z-score also had a 92-percent sensitivity for aortic dissection at a cutoff value of 2.12.

In women with aortic diameter ≥3.3 cm, researchers could identify no predictive factors for aortic dissection, including karyotype, body mass index, previous growth hormone therapy, aortic coarctation, and bicuspid aortic valve.

“The results contribute important information in the effort to predict a potentially fatal aortic dissection in patients with Turner syndrome,” the researchers said. “Larger pooled cohorts should focus on developing a risk assessment score to aid decision-making in the timing of prophylactic aorta surgery in women with Turner syndrome.”