Thoracic Aortic Atherosclerosis Research Articles

Imaging Techniques for Diagnosis of Thoracic Aortic Atherosclerosis.

The most severe complications after cardiac surgery are neurological complications including stroke which is often caused by emboli merging from atherosclerosis in the ascending aorta to the brain. Information about the thoracic aorta is crucial in reducing the embolization risk for both surgical open and closed chest procedures such as transaortic heart valve implantation. Several techniques are available to screen the ascending aorta, for example, transesophageal echocardiography (TEE), epiaortic ultrasound, TEE A-view method, manual palpation, computed tomography, and magnetic resonance imaging. This paper provides a description of the advantages and disadvantages of these imaging techniques.

Testin on Atherosclerosis in Rabbits

Background:The expression of TES, a novel tumor suppressor gene, is found to be down-regulated in the left anterior descending aorta of patients with coronary artery disease (CAD) compared with non-CAD subjects. This study aimed to investigate the expression of TES during the development of atherosclerosis in rabbits.Methods:Thirty-two New Zealand rabbits were randomly divided into a normal diet (ND) and high-fat diet (HFD) groups. Body weight and serum lipid levels were measured at 0, 4, and 12 weeks after diet treatment. The degree of atherosclerosis in thoracic aortas was analyzed by histological examinations. The expression of Testin in the tissue samples was inspected via immunohistochemical and immunofluorescence confocal microscopy. Real time-polymerase chain reaction and Western blot analysis were performed to evaluate the expression of TES/Testin at mRNA and protein levels in the aortic tissues.Results:After 12 weeks postenrollment, rabbits in HFD group had a higher level of serum lipids and atherosclerotic plaque compared to ND group (P < 0.05). Testin expression was detected at high levels in the endothelium and a weak expression on the subendothelium area. The expression of TES mRNA was markedly reduced by 10-fold in the aortic tissues in the HFD group compared with the ND group (P = 0.015), and the protein level was also significantly decreased in the HFD group (P < 0.05).Conclusions:Reduced TES/Testin expression is associated with the development of atherosclerosis, implicating a potentially important role in the pathogenesis of atherosclerosis.

Correlation of coronary and aortic atherosclerosis by computed tomographic coronary angiography

Background: Although CT coronary angiography (CTCA) images part of the thoracic aorta, current reports describe the aorta only in brief. This study investigates the relationship between coronary artery disease (CAD) and thoracic aortic atherosclerosis (TAA) in CTCA to assess if formal reporting of the aorta provides clinically useful information. Methods: CTCA of 100 patients referred for suspected CAD were retrospectively analysed for TAA. Ascending and descending thoracic aorta imaged were reconstructed with centreline tracking. Total plaque burden score (TPBS) that includes maximal plaque thickness and circumferential extent was measured. A novel volumetric method based on differential Hounsfield unit thresholds was used to calculate calcified and non-calcified TAA volumes. CAD severity was quantitated by CT-CAPS and vessel score. Results: Patients with TAA were older, more likely to be hypertensive, and had higher coronary calcium scores than those without TAA. TAA correlated between ascending and descending aorta, with the latter being significantly more diseased. Extent of CAD correlated with TAA, with 72% of patientswith coronary stenoses≥50%having TAA compared with 23% in those without (p 50% compared with 8% in those without TAA. The PPV and NPV of TAA in predicting coronary stenosis >50%were 59% and 89% respectively (p<0.001). Conclusions: Coronary and aortic atheroma are strongly correlated, and our findings suggest aortic disease arise later than CAD. TAA predicts significant CAD. Thus, formal assessment of visible aorta for TAA inCTCAmayhelp stratify CAD risk.

Association of aortic wall thickness on contrast-enhanced chest CT with major cerebro-cardiac events

There is a significant association between aortic atherosclerosis and previous major cardiovascular events. Particularly, thoracic aortic atherosclerosis is closely related to the degree of coronary and carotid artery disease. Thus, there is a rationale for screening the thoracic aorta in patients who undergo a chest computed tomography (CT) for any clinical question, in order to detect patients at increased risk of cerebro-cardiovascular (CCV) events. To estimate the association between either thoracic aortic wall thickness (AWT) or aortic total calcium score (ATCS) and CCV events. One hundred and forty-eight non-cardiac patients (78 men; 67 ± 12 years) underwent chest contrast-enhanced multidetector CT (MDCT). The AWT was measured at the level of the left atrium (AWTref) and at the maximum AWT (AWTmax). Correlation with clinical CCV patients' history was estimated. The value of AWTmax and of a semi-quantitative ATCS as a marker for CCV events was assessed using receiver-operating characteristic curve (ROC) analysis and multivariate regression analysis. Out of 148 patients, 59% reported sedentary lifestyle, 44% hypertension, 32% smoking, 23% hypercholesterolemia, 13% family history of cardiac disease, 12% diabetes, and 10% BMI ≥ 30 kg/m(2); 9% reported myocardial infarction, 8% aortic aneurism, 8% myocardial revascularization, and 2% ischemic stroke. Twenty-six percent of patients had a medium-to-high ATCS. Both AWTmax and AWTref correlated with hypertension and age (P < 0.002). At the ROC analysis, a 4.8 mm threshold was associated to a 90% specificity and an odds ratio of 6.3 (AUC = 0.735). Assuming as threshold the AWTmax median value (4.3 mm) of patients who suffered from at least one CCV event in their history, a negative predictive value of 90%, a RR of 3.6 and an OR of 6.3 were found. At the multivariate regression analysis, AWTmax was the only independent variable associated to the frequency of CCV events. Patients with increased thoracic AWTmax on chest MDCT could be considered at risk for CCV disease.

Mean platelet volume is associated with aortic intima-media thickness in patients without clinical manifestation of atherosclerotic cardiovascular disease.

Objective:Mean platelet volume (MPV) plays a pivotal role in the pathophysiology of atherosclerotic disease. Thoracic aortic intima-media thickness (IMT) was reported as an earlier marker of preclinical atherosclerosis than carotid IMT. However, the relationship between MPV and aortic IMT was not investigated. We aimed to assess the relationship between thoracic aortic IMT and MPV in patients undergoing transesophageal echocardiography (TEE) examination for different indications.Methods:We studied 190 patients (mean age 37.0±12.5 years) who underwent TEE for different indications. The patients who have known atherosclerotic disease were excluded from study. The patients were divided into 2 groups according to the median thoracic aortic IMT values (IMTlow group <13 mm and IMThigh group ≤13 mm). Platelet count and MPV were analyzed with an automated hematology analyzer. A multiple stepwise linear regression analysis was performed to identify the independent associations of thoracic aortic IMT.Results:The highest MPV values were observed in the IMThigh group compared with the IMTlow group (9.5±10 fL vs. 10.9±1.2 fL, p<0.001). Also, the IMThigh group had higher age, hs-CRP and uric acid levels (p<0.05 for all). Multiple linear regression analysis showed that aortic IMT was independently related with age (β=0.340, p<0.001), uric acid (β=0.111, p=0.041), hs-CRP (β=0.200, p<0.001), and MPV (β=0.482, p<0.001).Conclusion:MPV is independently related to the extent of subclinical thoracic aortic atherosclerosis. Increases in MPV may be a crucial biochemical marker for initial atherosclerosis.

Association between chronic kidney disease and thoracic aortic atherosclerosis detected using transesophageal echocardiography

Objective: Accelerated atherosclerosis occurs with a high frequency in patients with chronic kidney disease (CKD). We evaluated the association between CKD and thoracic aortic plaques using transesophageal echocardiography (TEE). Methods: This study population consisted of 297 patients who underwent TEE. Aortic plaques were evaluated in the proximal thoracic aorta (PTA) (from the ascending aorta to the aortic arch) and the distal thoracic aorta (DTA) (the descending aorta) using TEE. Aortic plaques were defined as complex plaques of ≥4 mm thickness and with ulceration or mobile components. CKD was defined as the estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2. The association between CKD and aortic plaques was evaluated using multivariate analysis after adjusting for traditional atherosclerotic risk factors. Results: Patients with CKD (n = 144) had a higher incidence of any plaques and complex plaques compared with those without CKD (n = 153) (85% vs. 47% and 42% vs. 17%, respectively, both P < 0.001). Univariate analysis indicated that the presence of CKD was significantly associated with complex plaques both in the DTA and the PTA (both, P < 0.001); however, multivariate analysis indicated that the presence of CKD was associated with only complex plaques in the DTA (P < 0.05), but not with those in the PTA. Conclusion: The presence of CKD was associated with complex aortic plaques, with this association being stronger for complex plaques in the DTA than those in the PTA.

Can aortic atherosclerosis or epicardial adipose tissue volume be used as a marker for predicting coronary artery disease?

PurposeTo investigate whether aortic atherosclerosis or epicardial adipose tissue (EAT) volume on multidetector computed tomography (CT) can predict the presence of significant coronary artery disease (CAD). Materials and methodsCoronary CT angiography was performed in 202 cases of CAD that were known or based on suspicion. Based on coronary CT angiography results, the patients with significant stenosis (≥50%) and without significant stenosis (<50%) were compared in terms of demographic characteristics, traditional cardiovascular risk factors, aortic atherosclerosis, and EAT volume. ResultsSignificant coronary artery stenosis was detected in 92 cases (45.5%). Although EAT volume was higher in the patients with significant stenosis, the difference between the two groups was not statistically significant. The presence of calcification in the descending aorta was significantly higher in the patients with significant stenosis than the patients without significant stenosis (50.4% and 15.4%, respectively, p=0.0001). The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rates of the presence of calcification in the descending aorta in predicting the presence of significant coronary artery stenosis were respectively found as 53.8%, 84.4%, 74.6%, 68.1%, and 70.3%. The sensitivity, specificity, PPV, NPV, and accuracy rates of the ≥2.45mm wall thickness of the descending aorta in predicting the presence of significant coronary artery stenosis were respectively found as 75.3%, 74.3%, 71.4%, 77.9%, and 74.8%. ConclusionThere is a strong relationship between thoracic aortic atherosclerosis and CAD. However, the relationship between EAT volume and CAD is not significant. The presence of aortic atherosclerosis can be used as an additional marker together with traditional cardiovascular risk factors for predicting CAD.

Can the ankle-brachial index be a predictor of the grade and localisation of thoracic aortic atherosclerosis?

Cardiologia CROATICA Introduction: The ankle-brachial index (ABI) is a strong marker of cardiovascular disease and is a predictor of cardiovascular events and mortality. In several studies, low ABI (<0,9) values were a predictor of atherosclerosis, such as peripheral artery disease (PAD), coronary artery disease and carotid artery disease. The atherosclerosis is a systemic disease, and recently we have learnt about the association of the PAD and cardiovascular diseases. One of the most important manifestations of the atherosclerotic process can be seen in the thoracic aorta. Patients with severe aortic arch plaque are at a high risk for stroke. We have investigated whether we can use the measurement of the ABI to predict the atherosclerosis of throracic aorta and its grade and localization as well. Patients and Methods: Transoesophageal echocardiography examination was made for the consecutive patient population of 62 adults due to other reasons, such as atrial fibrillation, detection of intracardiac sources of embolism, artificial valves function, pulmonary embolism. We observed the grade of the atherosclerosis in three different sites of the throracic aorta, in the visualized part of the ascendens aorta, on the aortic arch and in the descendens throracic part. We used the universally accepted classification of aortic atherosclerosis (grade 1-4). After it ABI measurement was performed for all patients with a a handheld Doppler device. We investigated the correlations between the aortic plaques severity, localization and age of patients and the ABI values. Results: In our consecutive population we found predictive value of ankle-brachial index for manifestation of atherosclerosis in the thoracic aorta. ABI measurements showed the same values independently for the observed atherosclerotic process in the thoracic aorta. Conclusion: The ABI measurement, as an indicator of PAD and the commonly used factor of cardiovascular risk assessment can not consequently predict the form appearing in the thoracic aorta of general atherosclerosis, neither considering the severity nor the localization. Morphologically detected various severities of aortic plaques in our study could not be explored by ABI measurements.

Paraoxonase (PON1) activity in patients with subclinical thoracic aortic atherosclerosis

High density lipoprotein (HDL), a powerful antioxidant, protects low density lipoprotein (LDL) particles against oxidative stress. By limiting LDL oxidation, HDL plays an important role in preventing atherosclerosis (AS). The antioxidant effect of HDL is mostly associated with the paraoxonase (PON1) activity. It has been known that increased aortic intima-media thickness (IMT) is an earlier marker AS than carotid IMT. We aimed to investigate the association between thoracic aortic IMT and serum PON1 activity. We studied 133 patients (mean age: 46.3 ± 8 years) who underwent transesophageal echocardiography (TEE) for various indications. The measurements of thoracic aortic IMT by TEE are classified into four grades (1, 2, 3 and 4). Serum PON1 activity was measured spectrophotometrically. Oxidative and anti-oxidative status was evaluated by measuring serum lipid hydroperoxide (LOOH), total anti-oxidant status (TAS). Serum PON1 activity was progressively decreasing from grade 1 IMT to grade 4 IMT (p < 0.001). However, serum LOOH was significantly lower and TAS was significantly higher in patients with grade 1 when compared with other grades. In multiple linear regression analysis, IMT was independently correlated with PON1 activity (β = -0.495, p < 0.001), TAS level (β = -196, p < 0.009), age (β = 0.145, p = 0.029) and LDL cholesterol level (β = 0.169, p = 0.009). Decreased PON1 activity was independently associated with the extent of thoracic AS. PON1 activity may play a role in pathogenesis of thoracic AS besides age, TAS and LDL cholesterol levels.

Thoracic aortic circumferential strain and atherosclerosis in patients with cerebral infarction

Thoracic aortic circumferential strain and atherosclerosis in patients with cerebral infarction

PD123319 Augments Angiotensin II-Induced Abdominal Aortic Aneurysms through an AT2 Receptor-Independent Mechanism

BackgroundAT2 receptors have an unclear function on development of abdominal aortic aneurysms (AAAs), although a pharmacological approach using the AT2 receptor antagonist PD123319 has implicated a role. The purpose of the present study was to determine the role of AT2 receptors in AngII-induced AAAs using a combination of genetic and pharmacological approaches. We also defined effects of AT2 receptors in AngII-induced atherosclerosis and thoracic aortic aneurysms.Methods and ResultsMale AT2 receptor wild type (AT2 +/y) and deficient (AT2 -/y) mice in an LDL receptor −/− background were fed a saturated-fat enriched diet, and infused with either saline or AngII (500 ng/kg/min). AT2 receptor deficiency had no significant effect on systolic blood pressure during AngII-infusion. While AngII infusion induced AAAs, AT2 receptor deficiency did not significantly affect either maximal width of the suprarenal aorta or incidence of AAAs. The AT2 receptor antagonist PD123319 (3 mg/kg/day) and AngII were co-infused into male LDL receptor −/− mice that were either AT2 +/y or −/y. PD123319 had no significant effect on systolic blood pressure in either wild type or AT2 receptor deficient mice. Consistent with our previous findings, PD123319 increased AngII-induced AAAs. However, this effect of PD123319 occurred irrespective of AT2 receptor genotype. Neither AT2 receptor deficiency nor PD123319 had any significant effect on AngII-induced thoracic aortic aneurysms or atherosclerosis.ConclusionsAT2 receptor deficiency does not affect AngII-induced AAAs, thoracic aortic aneurysms and atherosclerosis. PD123319 augments AngII-induced AAAs through an AT2 receptor-independent mechanism.

Uric acid and high sensitive C-reactive protein are associated with subclinical thoracic aortic atherosclerosis

Background and purposeThe detection of atherosclerotic lesions in the aorta by transesophageal echocardiography (TEE) is a marker of diffuse atherosclerotic disease. Hyperuricemia is a well-recognized risk factor for cardiovascular diseases. However, no data are available concerning the relationship between serum uric acid (UA) and subclinical thoracic aortic atherosclerosis. We aimed to investigate the association between thoracic aortic atherosclerosis and serum UA level. MethodsWe studied 181 patients (mean age 46.3±8 years) who underwent TEE for various indications. Four different grades were determined according to intima–media thickness (IMT) of thoracic aorta. UA and other biochemical markers were measured with an automated chemistry analyzer. ResultsTEE evaluation characterized thoracic aortic intimal morphology as Grade 1 in 69 patients, Grade 2 in 52 patients, Grade 3 in 31 patients, and Grade 4 in 29 patients. The highest UA level was observed in patients with Grade 4 IMT when compared with Grade 1 and 2 IMT groups (p<0.001 and p=0.014, respectively). UA levels in patients with Grade 3 and Grade 2 IMT were also higher than patients with Grade 1 IMT group (p<0.001, for all). In multiple linear regression analysis, IMT was independently associated with UA level (β=0.350, p<0.001), age (β=0.219, p=0.001), total cholesterol (β=−0.212, p=0.031), low-density lipoprotein cholesterol (β=0.350, p=0.001), and high sensitivity C-reactive protein (hsCRP) levels (β=0.148, p=0.014). ConclusionUric acid and hsCRP levels are independently and positively associated with subclinical thoracic atherosclerosis.

Aortic distensibility and its relationship to coronary and thoracic atherosclerosis plaque and morphology by MDCT: Insights from the ROMICAT Trial

BackgroundMulti-detector cardiac computed tomography (CT) allows for simultaneous assessment of aortic distensibility (AD), coronary atherosclerosis, and thoracic aortic atherosclerosis. ObjectivesWe sought to determine the relationship of AD to the presence and morphological features in coronary and thoracic atherosclerosis. MethodsIn 293 patients (53±12years, 63% male), retrospectively-gated MDCT were performed. We measured intraluminal aortic areas across 10 phases of the cardiac cycle (multiphase reformation 10% increments) at pre-defined locations to calculate the ascending, descending, and local AD (at locations of thoracic plaque). AD was calculated as maximum change in area/(minimum area×pulse pressure). Coronary and thoracic plaques were categorized as calcified, mixed, or non-calcified. ResultsAscending and descending AD were lower in patients with any coronary plaque, calcified or mixed plaque than those without (all p<0.0001) but not with non-calcified coronary plaque (p≥0.46). Per 1mm Hg−1 10−3 increase in ascending and descending AD, there was an 18–29% adjusted risk reduction for having any coronary, calcified plaque, or mixed coronary plaque (ascending AD only) (all p≤0.04). AD was not associated with non-calcified coronary plaque or when age was added to the models (all p>0.39). Local AD was lower at locations of calcified and mixed thoracic plaque when compared to non-calcified thoracic atherosclerosis (p<0.04). ConclusionsA stiffer, less distensible aorta is associated with coronary and thoracic atherosclerosis, particularly in the presence of calcified and mixed plaques, suggesting that the mechanism of atherosclerosis in small and large vessels is similar and influenced by advancing age.

Abstract 345: Associations Between Kidney Dysfunction and the Severity of Coronary and Aortic Atherosclerosis

Chronic kidney disease (CKD) is considered to be associated with increased risk of coronary artery disease (CAD). To elucidate the associations between kidney dysfunction (KD) and the severity of coronary and aortic atherosclerosis, we performed aortic black-blood MRI in 149 patients (pts) (age 64±9 yrs) undergoing coronary angiography. Regarding MRI, 9 slices of thoracic and 9 slices of abdominal aorta were obtained at 12-mm intervals. Plaque extent in each slice was scored. Severity of aortic atherosclerosis was represented as the sum of scores. On coronary angiograms, severity of coronary atherosclerosis was represented as the numbers of stenotic vessels and segments. KD was evaluated by eGFR. RESULTS: The 149 pts were divided into tertiles by eGFR: 51±10 (T1), 60±3 (T2) and 86±12 ml/min/1.73 2 (T3). CKD (eGFR&lt;60) was present in 41 (28%) pts. CAD (&gt;50% stenosis) and thoracic and abdominal aortic plaques were found in 105 (70%), 95 (64%) and 136 (91%) pts, respectively. Regarding coronary atherosclerosis, the number of &gt;25% stenotic coronary segments correlated with eGFR (r=-0.25, P&lt;0.005). Stepwise decrease in the number of &gt;50% stenotic vessels was found depending on eGFR tertiles: 1.5±1.0 (T1), 1.3±1.2 (T2) and 0.9±0.8 (T3) (P&lt;0.025). In multivariate analysis, reduced eGFR was associated with the severity of coronary atherosclerosis independent of risk factors. Regarding aortic atherosclerosis, the severity of thoracic aortic atherosclerosis correlated with eGFR (r=-0.22, P&lt;0.01), but abdominal aortic atherosclerosis did not (P=NS). The severity of thoracic aortic atherosclerosis decreased stepwise with eGFR tertiles: 3.0 (median) (T1), 2.0 (T2) and 1.0 (T3) (P&lt;0.02), whereas the severity of abdominal atherosclerosis tended to decrease on eGFR tertiles: 8.0 (T1), 7.0 (T2) and 6.0 (T3) (P=NS). However, in multivariate analysis, reduced eGFR was not an independent factor for thoracic or abdominal aortic atherosclerosis. CONCLUSION: The severity of coronary and thoracic, but not abdominal, aortic atherosclerosis correlated with the degree of KD. However, KD was an independent factor for coronary atherosclerosis but not for aortic atherosclerosis. KD is more likely to be associated with coronary atherosclerosis than aortic atherosclerosis.

Associations between LDL/HDL-cholesterol ratio and thoracic and abdominal aortic atherosclerosis assessed by MRI

Methods Aortic MRI was performed on Signa 1.5T Cvi using a phased-array body coil in 159 patients at high-risk for CAD. However, since statins affect LDL- and HDL-cholesterol levels, 64 patients who were taking statin were excluded from this study. Transverse PDW and T2W images of thoracic descending and abdominal aortas were obtained using an ECG-gated, double-inversionrecovery FSE sequence: TR=2 RR intervals, TE=10ms (PDW) and 60ms (T2W), 20-cm FOV, 4-mm slice thickness, 8-mm inter-slice gap, 256x256 acquisition matrix, and 32 echo-train. For each patient, 9 slices of thoracic aorta and 9 slices of abdominal aorta were obtained at 12-mm intervals, which each covered about 10-cm portion of thoracic aorta below the arch and 10-cm portion of abdominal aorta above the bifurcation of iliac artery. Plaque extent in each slice was scored 0 to 4 points by the percentage of luminal surface involved by plaque. The severity of aortic atherosclerosis was represented as sum of scores (plaque score). Results Among the 95 study patients without statin (age 63±9 years), thoracic and abdominal aortic plaques were found in 60 (63%) and 84 (88%) patients, respectively. The severities of both thoracic and abdominal aortic atherosclerosis correlated with age and blood pressures. Regarding lipid parameters, the severity of thoracic aortic atherosclerosis correlated with LDL-cholesterol (r=0.30) and HDL-cholesterol (r=-0.26) levels (P<0.01) and much better with LDL/HDL-cholesterol ratio (r=0.36, P<0.001). However, the severity of abdominal aortic atherosclerosis correlated with only HDL-cholesterol level (r=-0.29, P<0.005) but not with LDL-cholesterol or LDL/HDL-cholesterol ratio (P=NS). In multiple linear regression analysis, age and LDL/HDL-cholesterol ratio were the independent factors associated with thoracic aortic atherosclerosis, whereas age and HDL-cholesterol level as well as HbA1c and smoking were the factors associated with abdominal aortic atherosclerosis.

Comparison of Frequencies of Patent Foramen Ovale and Thoracic Aortic Atherosclerosis in Patients With Cryptogenic Ischemic Stroke Undergoing Transesophageal Echocardiography

Studies have shown an association between the presence of a patent foramen ovale (PFO) and cryptogenic stroke (CS) in patients aged <55 years. In addition, protruding atheromatous plaques in the ascending aorta and aortic arch are an independent risk factor for ischemic stroke in patients aged ≥55 years. The aim of this study was to determine the association of CS in the 2 age groups with PFO and with atheromatous plaques in the ascending aorta and in the aortic arch. Transesophageal echocardiograms in 229 patients evaluated for CS were compared to those in 314 patients evaluated for cardiac disease other than PFO with no histories of stroke (the control group). The prevalence of PFO and the presence of complex atheromatous plaques in the ascending aorta and aortic arch were determined in all patients and compared between the CS and control patients in the 2 age groups. The prevalence of PFO was significantly higher in patients with CS than in control patients among those aged <55 years (31 of 114 [27%] vs 24 of 171 [14%], p = 0.006) and those aged ≥55 years (28 of 115 [24%] vs 21 of 143 [15%], p = 0.049). The incidence of atrial septal aneurysm was similar in the 2 groups irrespective of patient age, as was the prevalence of complex atheromatous plaques. Multivariate analysis showed that PFO was independently associated with CS, irrespective of patient age (<55 years: odds ratio 2.4, 95% confidence interval 1.3 to 4.5, p = 0.01; ≥55 years: odds ratio 1.9, 95% confidence interval 1.1 to 3.5, p = 0.03). In conclusion, PFO was significantly associated with CS in younger (aged <55 years) and older (aged ≥55 years) patients. Atrial septal aneurysm and complex atheromas in the ascending aorta and aortic arch do not appear to be associated with CS.

Epicardial adipose tissue thickness predicts descending thoracic aorta atherosclerosis shown by multidetector computed tomography

Human epicardial adipose tissue (EAT) is a type of visceral adipose tissue functioning as an endocrine organ by secreting hormones and adipocytokines which have an important role in the atherosclerotic process. In this study, we aimed to assess the relationship between EAT measured by dual source multidetector computed tomography (MDCT) and descending thoracic aorta (DTA) atherosclerosis. A total of 148 patients who underwent MDCT for the evaluation of coronary artery disease were enrolled in this study. Thickness of the EAT was measured on contrast enhanced multiplanar reformat images with parasternal short axis view at basal, mid-ventricular and apical levels and horizontal long axis view. The atherosclerotic plaque was scored from 0 to 4 points by the percentage of the luminal surface at the cross sectional area of proximal, mid and distal segments of descending aorta. Among the study population, 84 (56.8%) were male and age was (mean ± standart deviation) 56.9 ± 11.7 years. In patients with critical coronary atherosclerosis, DTA atherosclerosis had a significant relationship with EAT (P = 0.012). Multivariate linear regression analysis revealed that in addition to critical coronary stenosis, age and total epicardial fat thickness were associated with aortic atherosclerosis (β value, 0.058 and 0.035; t value, 4.74 and 2.28, respectively; P < 0.05) after adjustment for traditional cardiovascular risk factors. In this study we demonstrated that atherosclerotic plaque burden of DTA was associated with the amount of EAT thickness among patients with suspected CAD shown by MDCT. Further large scale prospective studies are needed to address the interaction of EAT as well as the mediators of inflammation and adipocytokines with the development of atherosclerotic plaques in aorta and effects on cardiovascular outcomes.

Relationship of Hypertensive Retinopathy to Thoracic Aortic Atherosclerosis in Patients with Severe Arterial Hypertension

Arterial hypertension complicated with atherosclerosis presents the most common cause of death in hypertensive patients. Eyes suffer vascular damage as a result of high blood pressure (BP) and these changes can be detected by funduscopy, although its role has recently been questioned. The aims of this study were to assess the prevalence of atherosclerotic plaques and other disorders of thoracic aorta by transesophageal echocardiography (TEE) in patients with severe arterial hypertension of at least 1 year duration and to analyze the association between aortic atherosclerotic plaques and hypertensive retinopathy. This was a prospective TEE study conducted on 56 hypertensive patients from September 2008 to January 2010. Mean patient age was 62.8 ± 8.2 years and 67.86% of them were women. Aortic atherosclerotic plaques were found on 96.4% of patients, whereas hypertensive retinopathy was present on 94.6% of them. The mean thickness of maximal atherosclerotic plaque found on each patient was 4.3 ± 1.9 mm and 28.6% of patients had ulcerative plaques, while descending aorta was the most common location of the lesions. Grade 1 and 2 hypertensive retinopathy was diagnosed in 14.3% and 80.3% of patients, respectively. Hypertensive retinopathy correlated highly with aortic atherosclerotic score (r = 0.76, p < 0.0001), as it correlated significantly with aortic plaque thickness (r = 0.69, p < 0.0001). Application of funduscopy should be encouraged since it is a noninvasive procedure that provides a good window of retinal arterioles. Hypertensive retinopathy, even in mild forms, should serve as a marker of atherosclerosis elsewhere in the organism.

Relation Between the Incidence, Location, and Extent of Thoracic Aortic Atherosclerosis Detected by Transesophageal Echocardiography and the Extent of Coronary Artery Disease by Angiography

Atherosclerotic lesions in the thoracic aorta detected by transesophageal echocardiography (TEE) have been correlated with coronary artery disease (CAD). We determined whether simple or complex aortic plaques seen on transesophageal echocardiogram correlated with extent, location, and severity of CAD. The study population consisted of 188 patients who underwent TEE and coronary angiography. Atherosclerotic plaques seen on transesophageal echocardiogram were defined as (1) complex plaques in the presence of protruding atheroma ≥4-mm thickness, mobile debris, or plaque ulceration or (2) simple plaques in the absence of findings consistent with complex plaques. Extent of CAD was grouped into 4 groups according to number of coronary vessels with ≥70% stenosis. Numbers of patients with CAD with 0-, 1-, 2-, and 3-vessel disease were 99, 31, 28, and 30 respectively. Compared to patients without CAD, patients with CAD (n = 89) had a significantly greater prevalence of aortic atherosclerotic plaques irrespective of degree of plaque complexity or location (p <0.05). Multivariate analysis found that hypertension (odds ratio 3.0, 95% confidence interval 1.3 to 7.0, p = 0.013), diabetes mellitus (odds ratio 2.4, 95% confidence interval 1.1 to 4.9, p = 0.022), and aortic plaque (odds ratio 3.8, 95% confidence interval 1.8 to 8.2, p = 0.001) were significantly associated with CAD. There was a significant relation between simple and complex aortic plaques with increasing severity of CAD (p <0.001). Multivariate logistic regression analysis showed that complex plaque in the descending aorta (odds ratio 5.4, 95% confidence interval 1.8 to 16.4, p = 0.003) was the strongest predictor of CAD. In conclusion, simple and complex thoracic atherosclerotic plaques detected by TEE are associated with increasing severity of CAD. Complex plaque in the descending aorta was the strongest association with presence of CAD.

Prevalence and extent of calcification over aorta, coronary and carotid arteries in patients with rheumatoid arthritis

To evaluate the prevalence and pattern of arterial calcification in patients with rheumatoid arthritis (RA). Patients with RA are prone to premature atherosclerosis; nonetheless the prevalence and extent of atherosclerosis in different vascular beds and their relationship to each other remain unknown. We studied the distribution and extent of arterial calcification in 85 RA patients and 85 age-and sex-matched controls. Arterial calcification as determined by calcium score (CS) were measured using multi-detector computed tomography in thoracic aorta, coronary and carotid arteries. Compared with controls, RA patients had a significantly higher average CS and prevalence of CS > 0 in aorta, coronary and carotid arteries and overall arteries (all P < 0.05). After adjusting for age and sex, RA patients had a significantly higher relative risk of developing calcification in the aorta [Odds Ratio (OR) = 19.5, 95% Confidence Interval (CI): 8.0-47.6], followed by the carotid arteries (OR = 5.7, 95% CI:1.7-18.7) and coronary arteries (OR = 5.0, 95% CI:2.2-11.1) compared with controls (all P < 0.01). Amongst RA patients aged >60, 90% had diffuse arterial calcification, especially over the thoracic aorta, compared with 55% of controls who had arterial calcification clustered in the coronary arteries (P < 0.05). RA patients with total CS > 0 were older with a higher urea level and C-reactive protein than those without arterial calcification, no factor was found to be independently predictive for arterial calcification (all P > 0.05). Our results demonstrated that RA patients had earlier onset, more diffuse arterial calcification over multiple vascular beds and more preferential involvement of thoracic aorta, rather than coronary artery when compared with control.