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Published on: February 23, 2020
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Characterizing changes in abdominal aortic aneurysms using principal wall strain ultrasound elastography.
Baqir J Kedwai1, Zachary R Zottola1, Daniel J Lehane1
1Division of Vascular Surgery, University of Rochester Medical Center, Rochester, NY, United States.
Frontiers in Cardiovascular Medicine
|October 1, 2025
Summary
Baseline aortic wall strain predicts changes in abdominal aortic aneurysm (AAA) biomechanics over time. Ultrasound elastography can quantify these changes, potentially improving patient-specific risk stratification beyond size criteria.
Area of Science:
- Biomedical Engineering
- Cardiovascular Research
- Medical Imaging
Background:
- Abdominal aortic aneurysm (AAA) stability is influenced by aortic principal wall strain, a parameter linked to aneurysm growth rate.
- Current risk stratification for AAAs primarily relies on size-based criteria, potentially overlooking crucial biomechanical factors.
- Ultrasound elastography (USE) offers a non-invasive method to assess tissue mechanics.
Purpose of the Study:
- To characterize changes in pressure-normalized maximum mean aortic principal wall strain (ε̄ρ+/PP) in patients with AAAs over time using USE.
- To investigate the relationship between baseline strain levels and subsequent changes in strain, AAA growth, and clinical outcomes.
- To evaluate the potential of USE-derived biomechanical data for enhancing AAA risk stratification.
Main Methods:
- Axial ultrasound images of patient AAAs were acquired at two consecutive clinic visits.
- Pressure-normalized maximum mean aortic principal wall strain (ε̄ρ+/PP) was calculated using a novel finite element mesh technique.
- Patients were stratified into terciles based on their index ε̄ρ+/PP, and changes in strain, diameter, and clinical events were compared.
Main Results:
- The overall cohort showed a trend towards decreased maximum ε̄ρ+/PP (p=0.08) and a significant increase in maximum AAA diameter (p=0.04).
- Patients in the 'high-strain' tercile exhibited a significant reduction in strain over time compared to 'low-strain' and 'intermediate-strain' groups (p<0.01 and p=0.04, respectively).
- No significant differences in the rates of AAA growth, intervention, or rupture were observed between the strain terciles.
Conclusions:
- Baseline ε̄ρ+/PP effectively predicts the magnitude and direction of strain changes in AAAs over time.
- USE demonstrates potential for quantifying biomechanical alterations in the aortic wall, providing insights into AAA natural history.
- Integrating biomechanical data from USE with conventional size criteria may lead to improved patient-specific risk stratification tools for AAAs.
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