Spectrum of ascending aortic aneurysms at a peri urban tertiary hospital: an echocardiography-based study

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Thoracic ascending aortic (TAA) aneurysms are an important cause of clinical disability that require early detection by imaging methods for rapid and effective management. There is a paucity of data from Africa pertaining to TAA aneurysms. Purpose To describe the spectrum of TAA aneurysms at a Tertiary hospital in Africa. Methods A descriptive retrospective study was conducted based on clinical and echocardiographic imaging data of patients with clinical diagnosis of TAA, from October 2017-October 2022. Advanced strain imaging using speckle tracking echocardiography was performed to determine the circumferential strain (CS) of ascending aorta as a surrogate of compliance. Left ventricular global longitudinal, and basal and apical circumferential strain were also determined. Results The study comprised 139 cases of TAA aneurysms (52.5% females) with a mean age of 50±14.8 years, and 45 age and gender matched normal controls. Majority were of African ethnicity (95%). Main etiologies were hypertension (41.7%), human immunodeficiency virus (HIV) (36.6%), connective tissue disease (10.7%), congenital (2.2%) and mixed pathologies in 8.6% of patients. Two thirds of patients (69.7%) presented in heart failure and 10% of patients presented with aortic dissection. Thirty percent of the patients were in New York Heart Association (NYHA) class I, 59.7% were in NYHA II, 8.6 % in NYHA III and 1.4% of patients in NYHA class IV. Echocardiography revealed enlarged aortic dimensions compared to controls (P=0.00000). TAA aneurysms were complicated by severe aortic regurgitation (AR) in half (50.3%) of the patients, 25.8% had moderate AR and 14.3% of patients had mild AR. The left ventricular ejection fraction was reduced at 46.9±12.7% compared to controls (P=0.0000). Aortic CS was markedly reduced compared to controls (4.5±4.0% vs 10.3±4.37%, P=0.000). Left ventricular longitudinal strain (−13.9±3.9% vs −18.1±6.7%,P=0.000001), basal CS (−13.9±5.6% vs −17.9±5.8%, P=0.00008) and apical CS (−18.7±8.5% vs −30.6±3.8%,p = 0.0016) were all significantly reduced compared to controls. Majority (>50%) of the patients were on diuretic and anti-remodeling therapy for heart failure. Surgery was performed in 29.4% of patients. The overall estimated mortality was 7.9 %. Conclusion TAA aneurysms associated with hypertension and HIV are common in this population, and are associated with considerable morbidity and mo