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.