Limitations
There were several limitations to our study. First, this was a
retrospective study in a single center and there were patients who did
not have complete information available for analysis and were excluded,
incurring potential sampling bias.
Secondly, not all patients had both SoV and AAo dimensions measured, in
which case only the measurement available was documented. In regard to
imaging, there is an inherent difference in the methods used to measure
aortic diameters between echocardiography and advanced imaging
modalities. This problem is further compounded by inter-reader
variability and technique in both echocardiographic and advanced imaging
interpretation. Aortic diameters were not re-measured by the authors
since the original measurements were used by clinicians during their
decision-making process. Furthermore, the comparison and correlation
between advanced imaging, including CT and MR, and echocardiographic
measurements has been thoroughly investigated in the literature [8,
31–34].
Lastly, our study population was relatively homogenous in terms of
ethnicity and a more diverse sampling could aid in defining patterns of
AoD. A well-designed, multi-center prospective study evaluating AoD at
the time of diagnosis, initiation of medication, and surgery could
provide a greater yield of data in determining imaging strategies among
patients and circumvent some of these limitations.