Aortic and coronary atherosclerosis: a natural association?

Abstract

Several studies have demonstrated an association between coronary and aortic atherosclerosis [1–7]. For instance, risk factors are similar for the development of both thoracic aortic aneurysms and other cardiovascular diseases. Coronary artery disease (CAD) is highly prevalent in patients with thoracic aortic aneurysms, with a reported prevalence of 30– 70%. Knowledge of the underlying cardiac pathology can minimize perioperative risk and improve patient selection. This may allow for the optimal screening, diagnosis and management of patients with this common and potentially lethal disorder. Cardiovascular imaging may play a crucial role in the early detection of the total atherosclerotic burden. The atherosclerotic burden can be used as an indicator of the extent of the atherosclerotic process in the aorta through the use of both metabolic and morphologic data. Imaging of the aorta and the aortic wall can been performed by various imaging modalities such as transesophageal echocardiography (TEE) [1, 4], radionuclide imaging [8–13], cardiovascular magnetic resonance (CMR) [14–20], and computed tomography (CT), whereby CMR and CT also allow visualization of the coronary arteries [21–36]. Latest publications using TEE have reported a significant correlation between wall changes in the thoracic aorta and angiographic extent of coronary artery stenosis in patients with severe CAD [1, 2, 4]. Tatsumi et al. [37] showed that the combination of FDG-PET/CT depicted FDG uptake commonly in the affected thoracic aortic wall. The FDG uptake site was mostly distinct from the calcification site and may possibly be located in areas of metabolic activity of atherosclerotic changes i.e. macrophages. Adame et al. [38] developed an automated technique to trace the contours of the lumen and outer boundary of the aortic wall using CMR, allowing the measurement of aortic wall thickness in axial CMR images. The used algorithm proved to be a powerful tool to automatically draw the boundaries of the aortic wall and measure aortic wall thickness in aortic wall devoid of major lesions. Maroules et al. [39] showed that blackblood CMR of aortic atherosclerosis was very reproducible. Parallel imaging at 3-Tesla permitted shorter scan time compared with conventional 1.5Tesla imaging with comparable measures of atherosclerosis extent. Malayeri et al. [40] determined the relation between aortic wall thickness and aortic distensibility with traditional cardiovascular risk factors in the multi-ethnic study of atherosclerosis (MESA) cohort. In total, 1,053 participants in MESA underwent CMR for the measurement of aortic wall thickness and aortic distensibility. The authors showed that older age and higher blood pressure Editorial comment to the article by Jeltsch et al. (doi:10.1007/s10554-008-9373-6).