Kavatsyuk O. Aneurysm of the ascending aorta: age features, criteria of progression and risk stratification of complications.

The work is devoted to identifying the key factors in the development of aneurysm of the ascending aorta (AAA) and its predictors of progression. Patients younger (18?29 years) and mature (30?44 years) AAA was localized mainly in the aortic root (RA) and was associated with signs of connective tissue disorders. In patients with secondary (45?59 years) and senior (60?76 years) age, which were dominated by hypertension and coronary heart disease, often expanded distal ascending aorta (AA). To determine the dominant etiological factor AAA invited coefficient RA/AA. When the RA/AA > 1.11 probability of a positive prediction dysplastic aneurysm is 84%; if the RA/AA <0.88, the probability of its nondysplastic is 90%. It is shown that with a degree of expansion of the ascending aorta longer associating factors in young ? ?2 degree of mitral valve prolapse, abnormal left ventricular chord, underweight ?20%, chest deformity ?2 degree and hypermobility of joints; in adulthood ? joint hypermobility, skin extensibility increased, myopia, LV myocardial mass <235 g; in middle age ? structural indicators myocardial: interventricular septum ?10 mm, the relative thickness of the left ventricular wall ?0,41; in old age ? EF <46% and MMLV > 270g. The factors associated with the deterioration of echocardiographic indicators of myocardial and the progression of aortic enlargement: age> 58 years, body weight> 86 kg, HF FC> 1, HRV-score> 1 (calculation: 1 point HF?520 ms + 1 point LF/HF ?2,5). Identified independent predictors of informative cardiovascular complications in patients with AAA: total echocardiography-Ball (based on the remodeling of the left ventricle and the coefficient of RA/AA), the degree of aortic regurgitation, hypertension stage, the presence of atherosclerosis, atrial fibrillation, and the lack of continuous use of ?- blockers. We propose a range of risk stratification of cardiovascular complications in patients with AAA. According to this scale patients divided into groups - low (score <7) and high risk (score ?7), which makes a differentiated approach to the tactics of monitoring and treatment of patients of different groups.