Boczar KE, Boodhwani M, Beauchesne L, et al. - In view of the association of thoracic aortic aneurysm with high morbidity and mortality and the critical necessity for clinically useful strategies for medical management of thoracic aortic aneurysm, researchers here investigated how aortic stiffness and pulsatile arterial load affects future aneurysm expansion. They recruited and prospectively followed 105 consecutive, unoperated subjects with thoracic aortic aneurysm. Mean±SD age was 62.6±11.4 years, baseline aneurysm size was 46.24±3.84 mm, and follow-up time was 2.92±1.01 years. Aneurysm growth rate of 0.43±0.37 mm/y was observed. After adjusting for multiple comparisons, they identified future aneurysm growth to be independently linked with higher central systolic, and pulse pressures, carotid-femoral pulse wave velocity, amplitudes of the forward and reflected pressure waves, and lower total arterial compliance. This study thereby suggests an independent association of measures of aortic stiffness and pulsatile hemodynamics with future thoracic aortic aneurysm growth and provides novel insights into disease activity. Findings here underscore the role of central hemodynamic assessment to tailor novel risk assessment and treatment strategies to patients with thoracic aortic aneurysm.