Visual representation of measuring aortic function
Thoracic aortic aneurysms (TAA) are among the top 20 leading causes of death globally and are known as "silent killers". This is because TAAs present with very few symptoms before rapidly rupturing or dissecting, which requires surgical repair and has a mortality rate of 50%. This can be prevented by surgically removing the aneurysm, but this has associated risks as well. The management of TAAs therefore amounts to determining the point at which the risk of rupture exceeds the risk of surgical removal.
However, the standard to date has been to measure a single variable to determine this threshold. This measurement, the aneurysm size, is an imperfect measure of risk. It fails to account for any risk stratification, the timing of imaging, or sex-based data. In effect, this reduces the analysis of TAAs to a single imprecise input, painting all patients with the same brush.
The PREDICT trial seeks to introduce a new set of metrics based on measuring aortic function. Unlike the one-variable aneurysm size, aortic function is characterized using aortic stiffness, pulsatile hemodynamics, and arterial age. All three have already been independently correlated with TAA expansion (and, by extension, rupture risk).
The PREDICT trial is now validating these initial results through a larger, multi-center cohort study, which consists of a derivation cohort and a validation cohort. Confirming that aortic function is a truly accurate predictor of TAA expansion and rupture would redefine how TAAs are monitored and managed, marking the beginning of a new era of risk prediction and personalized TAA management.