Atheromatosis of the Thoracic Aorta as Predictor of Cardiovascular Mortality and Cerebrovascular and Coronary Events

Abstract

Objective To evaluate the severity of atheromatosis of the thoracic aorta and its relation with mortality and cerebrovascular and coronary events. Material and Methods Between 2005 and 2007, 601 patients (ps) were referred for evaluation with transesophageal echocardiography (TEE). Age: 64.53±13.61 years Male gender: 337ps. The following variables were included: Reason for ordering the study: embolic source (37.7%), endocarditis (22.1%), previous to cardioversion (11.5%), mitral valve disease (9.8%), other reasons (18.95%). Risk factors: diabetes, smoking habits, hypertension, dyslipidemia. Presence of atrial fibrillation. The patients were divided into two groups: With uncomplicated aortic plaques < 4 mm: ps = 465. With complex aortic atheromatosis (CAA): aortic plaques ≥ 4 mm, with ulcers, thrombi or aortic debris: ps = 136. Follow-up: 1596 days (mean: 759 days). A total of 520 ps (86.52%) were contacted; the following events were considered: transient ischemic attack or stroke, AMI, angina, revascularization and/or cause of mortality during that period. Multivariate analysis was used to identify independent predictors. A p value < 0.01 was considered statistically significant. Results Cardiovascular mortality: 3.2% (13/407 ps) in group a and 18.6% (21/113 ps) in group b (p<0.01). Combined vascular events: 91/407 ps (22.4%) in group a and 45/113 ps (39.8%) in group b (p<0.01). Multivariate analysis showed that CAA was an independent predictor of cardiovascular mortality (OR 4.54, 95% CI 1.52-13.58, p<0.01) and of cerebrovascular and/or coronary events (OR 3.33, 95% CI 1.66-6.67, p<0.01). Conclusions In this population, CAA was an independent predictor of cardiovascular mortality and combined vascular events.