Aortic Geometric Atlas: Centile-Based Reference Charts and Pathological Signatures Across the Adult Lifespan

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.