Severity Of Thoracic Aortic Atherosclerosis Research Articles

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<60) was present in 41 (28%) pts. CAD (>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 >25% stenotic coronary segments correlated with eGFR (r=-0.25, P<0.005). Stepwise decrease in the number of >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<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<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<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.

Thoracic aorta atherosclerosis burden index predicts coronary artery disease in patients undergoing transesophageal echocardiography

Aims The severity of thoracic aortic atherosclerosis (TAA) is associated with the extent of coronary artery disease (CAD). The aim of this study is to quantitative this relationship by developing a novel atherosclerotic index. Methods and results Two hundred and forty six consecutive patients underwent transesophageal echocardiography (TEE) and coronary angiography. A grading system was used to define the extent of TAA for individual segment of the thoracic aorta. TAA burden index (TAABI) was defined as the sum of the grading for each segment. Of the derived values TAABI had the greatest specificity and sensitivity in predicting CAD. A TAABI of greater than 6 was associated with 16-fold increase in the probability of CAD with a specificity of 88% and a sensitivity of 81%. The positive predictive value was 77% and the negative predictive value 90%. Conclusion A TAABI value of greater than 6 accurately predicts the presence of CAD. Patients with no or mild TAA are at low risk of having angiographically significant CAD.

Relationship Between Plasma Total Antioxidant Capacity and Thoracic Aortic Intima‐Media Thickness

It is known that antioxidants have an important role in the prevention of coronary artery disease (CAD). Low total antioxidant capacity (TAC) is a risk factor for ischemic heart disease. However, no data are available concerning the relationship between TAC and severity of thoracic aortic atherosclerosis. This study using multiplane transesophageal echocardiography (TEE) examined the relationship between atherosclerotic thoracic aortic intima-media thickness (TAIMT) and TAC. Twenty-nine patients (17 male, 12 female; mean age 36 +/- 8 years) without a history of atherosclerotic cardiovascular disease referred for TEE were included. The patients with obesity, hypertension, diabetes, and CAD were excluded. The TAC was measured for each patient using a more recently developed method. TAIMT and grade of thoracic aortic atherosclerosis were evaluated in each patient by using TEE. Mean TAC level was 1.91 +/- 0.53 mmol Trolox equiv/l. There was a negative and significant correlation between the TAC levels and TAIMT and grade of thoracic aortic atherosclerosis (r = -0.799, P < 0.001 versus r = -0.827, P < 0.001, respectively). Multiple linear regression analysis showed that TAIMT was independently associated with TAC (beta = -0.734, P < 0.001). The mean values of TAC in grade I, II, and III were 2.23 +/- 0.31, 1.58 +/- 0.31, and 1.04 +/- 0.27 mmol Trolox equiv/l, respectively (ANOVA P < 0.001). This study indicates that the TAC is an independent variable for TAIMT and it has a potential for an independent variable for atherosclerotic lesions in the major arterial locations.

Elevated Serum Lipoprotein(a) Level Is an Independent Marker of Severity of Thoracic Aortic Atherosclerosis

Lipoprotein(a) (Lp[a]) level is a risk factor for ischemic heart disease, cerebrovascular disease, and peripheral vascular disease. However, few data are available concerning the relationship between Lp(a) level and severity of thoracic aortic atherosclerosis. We hypothesized in this transesophageal echocardiography (TEE) study that Lp(a) level is a marker of severity of thoracic aortic atherosclerosis. Cross-sectional study. University hospital. Risk factors, coronary angiographic features, and TEE findings were analyzed prospectively in 119 patients with valvular disease. The following risk factors were recorded: age, gender, hypertension, smoking, lipid parameters, diabetes, body mass index, and family history of coronary artery disease. Serum levels of Lp(a) were measured for each patient. By univariate analysis, age, diabetes, hypertension, smoking, Lp(a), total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol levels were significant predictors of thoracic aortic atherosclerosis. There was a positive and significant correlation between the Lp(a) levels and the score of severity of thoracic aortic atherosclerosis (p = 0.0001). Multivariate regression analysis revealed that Lp(a) was an independent predictor of severity of thoracic aortic atherosclerosis (p = 0.0001). This prospective study indicates that serum Lp(a) level is an independent marker of severity of thoracic aortic atherosclerosis detected by multiplane TEE. These findings emphasize the role of Lp(a) as a marker of atherosclerotic lesions in the major arterial locations.

Complex Atheroma on Transesophageal Echocardiography

Letters to the EditorComplex Atheroma on Transesophageal Echocardiography Abdulhamid J. KinsaraMRCP, ABIM Abdulhamid J. Kinsara Consultant Cardiologist, King Khalid National Guard Hospital, P.O. Box 4409, Jeddah 21491, Saudi Arabia, E-mail: Search for more papers by this author Email the corresponding author at [email protected] Published Online:1 May 2002https://doi.org/10.5144/0256-4947.2002.259SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: We have read with interest the paper by Ismail et al. which we found stimulating as we have also encountered a similar case.1 We would like to share with readers some of our observations which we consider important. The authors used a cut-off of 5 cm for simple a atheroma of <5 mm. Most studies actually use 4 mm including the two original articles that address this issue.2–4They also defined complex atheroma as intimal thickening >5 mm with raised, protruding, ulcerated or mobile plaques. However, the consensus in the literature is that the size is not the absolute criterion for designating a lesion as a complex atheroma. Indeed, any lesion that is mobile or ulcerated can still be designated as complex irrespective of its size. In addition, any of them has a high risk of subsequent vascular events.5The authors also did not define the age at which the presence of atherosclerotic lesions in the thoracic aorta is a strong predictor of coronary artery disease (CAD), since it has been described only in patients <70 years old.6 I would like to point out that a recent prospective study indicated that TEE examination of thoracic atherosclerotic plaque is a powerful predictor of absence of significant CAD in patients with valvular heart disease, namely, aortic stenosis.7 It would have been interesting if the author had included other landmarks during the study like mitral annular calcification. Mitral annular calcification, combined with aortic plaque, is highly predictive not only for strokes, but also for deaths associated with cerebral embolism and total cardiac deaths. They are probably strong markers for higher severity of coronary artery disease. The two are more predictive if both are present simultaneously compared to the presence of either alone.8The value of the publication would have increased considerably if the authors had been able to provide the results of homocysteine or fibrinogen level in the blood as either could be independent predictor of the presence and severity of thoracic aortic atherosclerosis.9 We hope the comments on this interesting publication will be of interest to the readers and help generate more information.ARTICLE REFERENCES:1. Ismail M, El-Gamal A, Ibraheim A. "Aortic plaque on transesophageal echocardiography as a marker for coronary artery disease" . Ann Saudi Medicine. 2000; 20:461–3. Google Scholar2. Amarenco P, Duyckaerts C, Tzourio C, Henin D, Bousser MG, Hauw JJ. "The prevalence of ulcerated plaques in the aortic arch in patients with stroke" . N Engl J Med. 1992; 326:221–5. Google Scholar3. The French Study of Aortic Plaques in Stroke Group. "Atherosclerotic disease of the aoritic arch as a risk factor for recurrent ischemic stroke" . N Engl J Med. 1996; 334:1216–21. Google Scholar4. Zabalgoitia M, Halperin JL, Pearce LA, Blackshear JL, Asinger RW, Hart RG. "Transesophageal echocardiographic correlates of clinical risk of thromboembolism in nonvalvular atrial fibrilation. Stroke Prevention in Atrial Fibrilation III Investigators" . J Am Coll Cardiol. 1998; 31:1622–6. Google Scholar5. Geraci A, Weinberger J. "Natural history of aortic arch atherosclerotic plaque" . Neurology. 2000; 54:749–51. Google Scholar6. Parthenakis FI, Kochiadakis GE, Skalidis EI, Kanakaraki MK, Mezilis NE, Kanoupakis EM, et al.. "Aortic atherosclerotic lesions in the thoracic aorta detected by multiplane transesophageal echocardiography as a predictor of coronary artery disease in elderly patients" . Clin Cardiol. 2000; 23:734–9. Google Scholar7. Tribouilloy C, Peltier M., Rey JL, Ruiz V, Lesbre JP. "Use of transesophageal echocardiography to predict significant coronary artery disease in aortic stenosis" . Chest. 1998; 113:671–5. Google Scholar8. Kamensky G, Lisy L, Polak E, Piknova E, Plevova N. "Mitral annular calcifications and aortal plaques as predictors of increased cardiovascular mortality" . JCardiol. 2001; 37(Suppl 1):21–6. Google Scholar9. Tribouilloy CM, Peltier M, Iannetta Peltier MC, Trojette F, Andrejak M, Lesbre JP. "Plasma homocysteine and severity of thoracic aortic atherosclerosis" . Chest. 2000; 118:1685–9. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 22, Issue 3-4May-July 2002 Metrics History Published online1 May 2002 InformationCopyright © 2002, Annals of Saudi MedicinePDF download

The associations among thoracic aortic atherosclerosis, coronary atherosclerosis and the function of high density lipoprotein

We sought to determine the associations among thoracic aortic atherosclerosis, coronary atherosclerosis and the function of high density lipoprotein (HDL) in a case-control study. The function of HDL can be assessed by the fractional esterification rate of cholesterol in low density lipoprotein (LDL)- and very low density lipoprotein (VLDL)-depleted plasma (FER HDL), which reflects a balance of cholesterol uptake by HDL and cholesterol ester (CE) transport in the reverse cholesterol transport (RCT) system in humans. Cases ( n=51, age: 64.3±8.0 years) and controls ( n=51, age: 58.7±13.1 years) were defined as subjects with/without angiographically proven coronary artery disease (CAD), respectively and examined for thoracic aortic atherosclerosis (TAA) by transesophageal echocardiography. The severity of TAA was determined by the ratio of average sclerotic areas (ASA) and average sclerotic lengths (ASL). The cases had significantly ( P<0.05) higher values of ASA (0.22±0.18 vs. 0.10±0.11), ASL (0.82±0.56 vs. 0.48±0.45), ASA/ASL ratio (0.23±0.08 vs. 0.17±0.09) and FER HDL (10.3±3.8 vs. 8.3±3.5% per hour) and lower HDL-C and apolipoprotein A-I levels than the controls. A receiver operating characteristic (ROC) curve analysis showed that ASA/ASL and FER HDL had moderate discriminating ability for CAD and the diagnostic accuracy of ASA/ASL was better than that of FER HDL (area under ROC curve: 0.703 and 0.656, respectively). Multivariate logistic regression analysis indicated that ASA/ASL and FER HDL were independent indicators for CAD [odds ratio (95% CI): 7.5 (2.4–27), P<0.01 and 4.0 (1.2–15), P<0.05] after adjusting for age, gender and other conventional risk factors, and that a high FER HDL value greatly increased the relative risk of CAD associated with a high ASA/ASL. The function of HDL, as assessed by FER HDL, enhances the ability of TAA to predict CAD.

Plasma Homocysteine and Severity of Thoracic Aortic Atherosclerosis

Plasma homocysteine level is a risk factor for coronary events, stroke, and peripheral atherosclerotic disease. However, few data are available concerning the relationship between homocysteine level and severity of thoracic aortic atherosclerosis. We hypothesized in this multiplane transesophageal echocardiography (TEE) study that homocysteine level is a marker of the presence and severity of thoracic aortic atherosclerosis. Cross-sectional study. University hospital. Risk factors, angiographic features, and TEE findings were analyzed prospectively in 82 valvular patients. The following risk factors were recorded: age, gender, hypertension, smoking, lipid parameters, diabetes, body mass index, and family history of coronary artery disease. Plasma levels of homocysteine, vitamin B(12), and folic acid were measured for each patient. By univariate analysis, age, diabetes, hypertension, smoking, family history of coronary artery disease, and levels of homocysteine, total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol were significant predictors of the presence of thoracic aortic plaques. There was a positive correlation between the plasma homocysteine levels and the score of severity of thoracic atherosclerosis (r = 0.48; p = 0.0001) as well as between the homocysteine levels and the grades of severity of aortic intimal changes (p = 0.0008). Multivariate regression analysis revealed that homocysteine was an independent predictor of the presence and severity of thoracic aortic atherosclerosis. This prospective study indicates that plasma homocysteine level is a marker of severity of thoracic atherosclerosis detected by multiplane TEE. These findings emphasize the role of homocysteine as a marker of atherosclerotic lesions in the major arterial locations.

Relation between low-density lipoprotein cholesterol and thoracic aortic atherosclerosis

This prospective study, which included 320 patients, showed that total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol/high-density lipoprotein cholesterol, and triglycerides correlate with thoracic aortic atherosclerosis. Low-density lipoprotein cholesterol is identified as an independent predictor of thoracic aortic plaque related to the severity of thoracic aortic atherosclerosis.

Use of Transesophageal Echocardiography to Predict Significant Coronary Artery Disease in Aortic Stenosis

This study was conducted to examine if the use of multiplane transesophageal echocardiography (TEE) could predict the absence or the presence of significant coronary artery disease (CAD) in patients with aortic stenosis. Prospective study. University hospital. Clinical, angiographic features and TEE findings were prospectively analyzed in 132 consecutive patients with aortic stenosis. In 63 patients with significant CAD, 57 had thoracic aortic plaque on TEE studies. In contrast, aortic plaque existed in only 19 of the remaining 69 patients with normal or mildly abnormal coronary arteries. Therefore, the presence of aortic plaque on the TEE identified significant CAD with a sensitivity of 90.5%, a specificity of 72.5%, and with positive and negative predictive values of 75.0% and 89.3%, respectively. There was a significant relation between the severity of thoracic aortic atherosclerosis and the severity of CAD (p<0.0001). Multivariate logistic regression analysis revealed that aortic plaque, angina, and age were independent predictors of CAD. Aortic plaque was the most significant independent predictor. This prospective study indicates that TEE examination of thoracic atherosclerotic plaque is a powerful predictor of absence of significant CAD in patients with aortic stenosis.

Fibrinogen is an Independent Marker for Thoracic Aortic Atherosclerosis

The fibrinogen level is an independent risk factor for coronary events and stroke, but no detailed data are available concerning fibrinogen and atherosclerotic disease of the thoracic aorta. This prospective study using multiplane transesophageal echocardiography examined the relation between atherosclerotic thoracic aortic plaque and fibrinogen level. One-hundred forty-eight patients (65 ± 11 years) with valvular heart disease underwent multiplane transesophageal echocardiography and coronary angiography. We measured plasma fibrinogen level for each patient and recorded the following cardiovascular risk factors: age, sex, systemic hypertension, history of smoking, hypercholesterolemia, diabetes mellitus, body mass index, and family history of coronary artery disease (CAD). Patients with thoracic aortic plaque had a higher level of plasma fibrinogen (p = 0.0001), were older (p = 0.0001), and had significantly more risk factors: history of smoking (p = 0.009), hypertension (p = 0.008), hypercholesterolemia (p = 0.0001), diabetes mellitus (p = 0.01), and family history of CAD (p = 0.003). Multivariate logistic regression analysis of fibrinogen level and risk factors revealed 4 independent predictors of thoracic aortic plaque: fibrinogen, age, hypercholesterolemia, and history of smoking. Fibrinogen was also an independent predictor of CAD. There was a relation between fibrinogen levels and the severity of aortic atherosclerosis (r = 0.46; p = 0.0001) and the severity of CAD (r = 0.30; p = 0.0001). This prospective study indicates that fibrinogen is an independent marker for thoracic aortic plaque related to the severity of thoracic aortic atherosclerosis and confirms that fibrinogen constitutes an independent marker for CAD related to the severity of angiographically evaluated coronary atherosclerosis.

Relationship between hemoglobin A1c (HbA1c) levels and severity of thoracic aortic atherosclerosis

Relationship between hemoglobin A1c (HbA1c) levels and severity of thoracic aortic atherosclerosis