3D speckle tracking for evaluation of dilative ascending aorta biomechanics: sensitive markers for ascending aorta longitudinal strain predict aortic root dilation rate

Ascending aortic aneurysm is a predisposing condition for rupture and a risk factor for dissection. In autopsy studies, the prevalence of aortic dissection ranges from 0.2% to 0.8%, whereas in most population-based studies, the incidence of aortic dissection ranges from 0.61 to 7.2/100 000 persons. The surgical option, or endovascular treatment, remains the only effective treatment. Very often, the aorta ruptures at echocardiographic or CT values lower than those indicated by the guidelines for performing an operation. Therefore, research efforts are aimed at discovering new markers for earlier diagnoses to intervene preventively on dilated aortas at risk of rupture. The protocol of our study involves the evaluation of the longitudinal deformation of the dilated ascending aortas that must undergo surgery and their histological data. The objective would be to identify whether the altered distensibility of the aorta upon echocardiographic control is confirmed by histological data in terms of stiffness or other pathophysiological aspects. This would allow the identification of new markers for the early diagnosis of aortas at increased risk of rupture, even if they do not reach the diameters indicated by the guidelines. Patients over 18 years of age, diagnosed with ascending aortic aneurysm with simultaneous aortic valve disease, will be considered for the study. They will be analyzed by intraoperative transesophageal echocardiography with speckle tracking echocardiography during five heart beats using 2D and 3D images. The study will define the 3-segment ascending aorta (aortic ring, aortic root and proximal ascending aorta) and the four quadrants of the ascending aorta (internal curvature, anterior wall, external curvature and posterior wall). A short-axis view at the level of maximum dilation, a long-axis view of the ascending aorta and a histological examination of the aorta. Data will be collected on demographics, clinical data, screening, family history, adherence to study methods, intraoperative details, intraoperative histology and the type of surgery performed. The results of our study will be published in a peer-reviewed journal, and the abstracts will be presented at national or international conferences.