Project Summary Aneurysms are permanent, local dilations of the blood vessel. The growth, rupture and dissection of aortic aneurysms induce a significant rate of patient mortality. The current standard of care relies on a reactive strategy of surveillance over a period of 1 to 5 years to monitor the growth rate of an aneurysm. This project seeks to validate the predictive accuracy of an ab-initio physiomarker in diagnosing both the growth and dissection of an aneurysm during an initial evaluation. By capturing the underlying physical mechanism driving aneurysm development, the physiomarker can be used to determine whether a cross section of the blood vessel will dilate permanently—whether an aneurysm will grow or remain stagnant over time. This predictive strategy can inform immediate treatment or surgical intervention at the initial evaluation of the patient instead of waiting until follow-up to monitor for growth. The specific aims of the project are threefold. The first is to verify the biomechanical accuracy of the physiomarker, determine its relationship with tissue remodeling modalities, and quantify nonlinear effects using an established in vitro experiment. The hemodynamic and vessel wall properties will be controlled to examine the growth and stagnation regimes. The second is to validate the accuracy of the physiomarker in patients with associated aortopathies like Marfan syndrome or biscuspid aortic valves, which may typically act as confounding factors for regression-based methods but are not expected to affect this ab-initio framework. Retrospective observational studies will be performed to examine the accuracy of the physiomarker in the presence of these factors. Lastly, the physiomarker will be measured using flexible, wearable sensors, either in conjunction with echocardiography or as a standalone platform. This will be carried out via carefully controlled, prospective observational studies over 1 to 2 years. Both modalities will offer a safer, cheaper and more accurate way to predict aneurysm growth and dissection. If the standalone sensor platform exhibits sufficient accuracy in measuring the physiomarker, it will enable more frequent, at home monitoring of aneurysms, akin to how blood pressure monitors can be used to track the development of hypertension. Additionally, it will enable much broader screening for aneurysms in the general population as part of routine health checkups.