Aortic Geometric Atlas: Centile-Based Reference Charts and Pathological Signatures Across the Adult Lifespan
Year: 2026
Type: preprint
Study design: Observational Study
Abstract: The aorta is a site of major cardiovascular burden, yet its clinical assessment on computed tomography (CT) remains limited to manual diameter measurements. Here we present the Aortic Geometric Atlas, a comprehensive characterization of thoracic aortic geometry, realized through the Aortic Geometry Toolkit (AGT), an automated pipeline we developed to extract 38 aortic geometric phenotypes (AGPs) across anatomically delineated subsegments. Applying AGT to 62,366 participants representing 140,319 CT studies, we constructed sex-specific, continuous, centile-based reference ranges spanning nine decades of the adult lifespan from 35,648 participants without aortic disease. We then performed a phenome-wide time-to-event analysis for incident disease, identifying 861 prognostic associations across 155 phecodes, with non-caliber geometry contributing predictive value beyond diameter, and derived disease-specific AGP signatures for cardiovascular risk stratification. Together, the Aortic Geometric Atlas provides a population-scale reference for individualized aortic assessment, positioning AGPs as early subclinical markers of incident cardiovascular disease.
Source: medRxiv
Authors: Cameron A. Beeche, Hamed Tavolinejad, Zhirui Li, Zirui Fan, Bingxin Zhao, Heng Wei, Leonard Steger, Rakesh Sharma, Luke Ni, Saif Zaman, Jeffrey Duda, James Gee, Anurag Verma, Hersh Sagreiya, Scott M. Damrauer, Michael G. Levin, Daniel Rader, Ari Goldberg, Julio A. Chirinos, Walter R. Witschey, Penn Medicine Biobank
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: American Heart Association, Bristol-Myers Squibb, University of Pennsylvania, Emory University, Virginia Commonwealth University, University of Pennsylvania Health System, NGM Biopharmaceuticals, Vascular Society, National Institutes of Health, Perelman School of Medicine, University of Pennsylvania, National Institute on Aging, National Heart, Lung, and Blood Institute, National Institute of Diabetes and Digestive and Kidney Diseases, National Institute of Biomedical Imaging and Bioengineering, National Center for Advancing Translational Sciences
Awards: HeartShare: Next-Generation Phenomics to Define Heart Failure Subtypes and Treatment Targets - Clinical Centers, Advanced Normalization Tools, Blockade of calcium channels and beta adrenergic receptors for physiologic abnormalities in heart failure with preserved ejection fraction (BLOCK HFpEF), G2349321998, VASCULAR EFFECTS OF DIETARY SALT IN HUMANS WITH SALT-RESISTANT BP, Efficacy of Fenofibrate for COVID-19: A phase II randomized controlled trial, G6104092673, G770363488, ITK-Lung: A Software Framework for Lung Image Processing and Analysis, Cardiac MR imaging of hemorrhagic reperfusion injury after myocardial infarction, Developing Oral LT3 Therapy for Heart Failure, G9000019884, G9000111082, G9000149996, G9000313256, Multimodal AI for aortic disease, Center for Advanced Metabolic Imaging in Precision Medicine (CAMIPM), Subclinical Vascular Contributions to Alzheimer's Disease: The Multi-Ethnic Study of Atherosclerosis (MESA) Multisite Study of AD (Renewal), Clinical Epidemiology Training in Gastroenterology, Targeting Skeletal Muscle Perfusion and Oxidative Capacity in HFpEF, Genetic determinants of thoracic aortic stiffness and remodeling, Cardiovascular Risk, Vascular and Kidney Damage in COVID-19 Survivors, Non-invasive imaging of reactive oxygen species in reperfusion injury myocardial infarction, Institutional Clinical and Translational Science Award, Cardiovascular Consequences of Duchenne and Becker Muscular Dystrophinopathies, Multimodality and Longitudinal Artificial Intelligence for Diagnosis and Prognosis in Hepatic Steatosis, Ethical Multimodal AI Development for Obesity, Diabetes and Digestive Disease
OpenAlex ID: W7167710403