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

Abstract

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 mortality. CS of the aneurysmal aorta was significantly reduced translating into stiffer aortas, possibly at risk for further dilation and dissection.