The decision on when to operate on ascending aortopathy should be guided by CE-CTA measurements and refined with indexed metrics to optimize timing.

In a cohort of over 5,000 patients who did not have surgery, CSAH identified more at-risk individuals than absolute diameter alone, while AHI highlighted a high-risk subset with good specificity.

A retrospective study of 7,459 patients with ascending aortopathy used both TTE and CE-CTA within a year and tracked a composite long-term endpoint including death, dissection, or rupture.

Transthoracic echocardiography tends to underestimate aorta size versus CE-CTA, with notable discordance in classifying mid-range and larger aneurysms across the root and mid-ascending sections.

An absolute diameter of at least 5 cm remains a risk predictor, but height-indexed metrics offer stronger prognostic power, notably AHI above 3.20 cm/m and CSAH above 10 cm²/m.

A combined approach—CE-CTA measurements with indexed metrics—may optimize risk stratification and inform surgical timing for ascending aortopathy.