Key result
Higher baseline posterior-left ultrasound strain is linked to ~32% faster annual AAA growth.
Why the study?
AAA surveillance relies on diameter measurements despite ruptures below repair thresholds, and the relationship between localised wall strain and future AAA growth remains unexplored.
Do ultrasound strain patterns predict annual diameter growth in patients with infrarenal abdominal aortic aneurysms?
Cohort (n=278)
Do ultrasound strain patterns predict annual diameter growth in patients with infrarenal abdominal aortic aneurysms?
p-value: p=0.041
Ultrasound strain mapping of the AAA wall provides biomechanical information that predicts future aneurysm growth independently of baseline diameter, potentially improving risk stratification.
Strain patterns may aid AAA growth prediction beyond diameter; leaves open prospective validation before surveillance changes.
OBJECTIVE: Surveillance of abdominal aortic aneurysms (AAAs) traditionally relies on diameter measurements, yet up to 10% of ruptures occur below repair thresholds. The relationship between localised wall strain and future AAA growth remains unexplored. This study aimed to examine localised AAA wall strain patterns and their association with aneurysm growth. METHODS: This was a prospective study of patients with an infrarenal AAA under surveillance with conventional ultrasound. In a standard examination, ten second ultrasound videos (cineloops) were acquired in transverse plane with the curved array transducer at the maximum anteroposterior diameter during breath hold. From these cineloops, strain patterns were extracted and analysed via functional data analysis to assess changes over time and associations with annual AAA diameter growth. RESULTS: Two hundred and seventy-eight patients (median age 73 years; 238 men) across 1 117 clinic visits were included, with a median follow up of 2.3 years. Progressive vessel wall stiffening and increasingly homogeneous strain patterns were observed over time (p < .001). Baseline strain patterns were statistically significantly associated with future AAA growth (p = .006), especially in specific regions. In the posterior left and right vessel wall, a 5% point increase in strain corresponded to a 31.9% and 6.7% higher annual growth rate, respectively. Conversely, the same increase at the anterior middle wall was linked to a 33.3% reduction in annual growth rate. These associations remained statistically significant after adjusting for baseline diameter, age, sex, smoking, hypertension, and diabetes (p = .041). CONCLUSION: Ultrasound strain mapping identified biomechanical regions linked to AAA progression. Strain patterns were associated with future growth independently of diameter, supporting their potential utility in complementing diameter in AAA monitoring and risk stratification.
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Lorenzen et al. (2026) conducted a cohort in Infrarenal abdominal aortic aneurysm (AAA) (n=278). Localised AAA wall strain patterns was evaluated on Annual AAA diameter growth (p=0.041). A 5% point increase in baseline ultrasound strain at the posterior left vessel wall was independently associated with a 31.9% higher annual abdominal aortic aneurysm growth rate (p=0.041).
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