Purpose of review: Pathophysiologic changes of aortic tissue may not always manifest as aneurysms, nor does the size of an aneurysm necessarily represent the severity of tissue abnormality - approximately 40% of patients who present with dissection have aortic diameters below criteria recommended for surgical resection. Noninvasive imaging-based quantification of aortic biomechanics has the potential to improve our knowledge of the pathophysiology of aortic disease, including patient-specific risk-stratification and intraoperative surgical decision-making.
Recent findings: We summarize the current state of clinical utilization of two-dimensional speckle tracking echocardiography (2D-STE) aortic strain to better understand the pathophysiology, clinical implications, and risk stratification of aortic disease.
Summary: 2D-STE has demonstrated promising early results as an imaging modality to determine clinically relevant measures of aortic tissue mechanical properties. Further large multinational, multiethnic, age-stratified, and sex-stratified measures of normal aortic strain measurements, as well as comparison studies with alternative imaging techniques, will be needed to properly elucidate the role echocardiography will play in the clinical management of aortic disease.