Browsing by Author "Nadel, James"

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    Site-specific analysis of thoracic aortic aneurysm and cardiovascular mortality: Insights from the National Echo Database Australia
    (2025) Nadel, James; Suinesiaputra, Avan; Paratz, Elizabeth D.; Humphries, Juile; Young, Alistair; Botnar, René Michael; Celermajer, David S.; Strange, Geoff; Playford, David
    Background Aortic diameter remains the most utilised criterion for considering surgical correction. In uncomplicated cases guidelines do not differentiate between the size of aneurysms at the root and ascending aorta. In order to improve practice, greater understanding of site-specific TAA is needed. A nationwide echocardiographic dataset linked to mortality outcomes was examined to determine how TAA affects cardiovascular (CVD) mortality.Methods The National Echo Database Australia (NEDA) was examined for aortic dimensions at the sinuses of Valsalva (SoV), sinotubular junction (STJ) and ascending aorta (AscAo). Patients were stratified according to absolute aortic diameters and grouped as normal (<4cm), mild (4.0-4.5cm), moderate (4.5-5cm) and severely (>5cm) dilated at the prescribed thoracic aortic sites. Mortality data was linked from the National Death Index.Results 477,501 echocardiographs from 175,158 patients with 2,897,357 patient-years of follow-up were included. Severe TAA at any site increased likelihood of 10-year CVD mortality compared to normal aortic diameters (31% vs. 14%, p<0.0001), with incremental increase in probability of CVD death when moving from the proximal to distal ascending aorta; CVD mortality at SoV 30% (HR 1.79; CI 1.2-2.67; p=0.004), STJ 41% (HR 1.91; CI 1.11-3.29; p=0.002) and AscAo 45% (HR 3.96; CI 2.06-7.64; p<0.001).Conclusions Severe TAA increases the probability of cardiovascular mortality. Given the low event rate of aortic death (0.2%) this is not solely explained by increased dissection risk. Interestingly, there is a doubling of CVD mortality likelihood when moving from the proximal to distal ascending aorta. These results suggest those with severe AscAo dilatation may be at higher CVD risk compared to those with aortic root aneurysms, identifying new considerations for risk stratification and surgical management.
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    The future of MRI in thoracic aortopathy: blueprint for the paradigm shift to improve management
    (2025) Nadel, James; Rodríguez Palomares, José; Phinikaridou, Alkystis; Prieto Vásquez, Claudia Del Carmen; Masci, Pier Giorgio; Botnar, René Michael
    Thoracic aortopathies result in aneurysmal expansion of the aorta that can lead to rapidly fatal aortic dissection or rupture. Despite the availability of abundant non-invasive imaging tools, the greatest contemporary challenge in the management of thoracic aortic aneurysm (TAA) is the lack of reliable metrics for risk stratification, with absolute aortic diameter, growth rate and syndromic factors remaining the primary determinants by which prophylactic surgical intervention is adjudged. Advanced MRI techniques present as a potential key to unlocking insights into TAA that could guide disease surveillance and surgical intervention. MRI has the capacity to encapsulate the aorta as a complex biomechanical structure, permitting the determination of aortic volume, morphology, composition, distensibility and fluid dynamics in a time-efficient manner. Nevertheless, current standard-of-care imaging protocols do not harness its full capacity. This state-of-the-art review explores the emerging role of MRI in the assessment of TAA and presents a blueprint for the required paradigm shift away from aortic size as the sole metric for risk stratifying TAA.