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Plaque and structural characteristics of the descending thoracic aorta using transesophageal echocardiography
G M Lanza1, M Zabalgoitia-Reyes, L Frazin
1Department of Internal Medicine, Northwestern University, Chicago, Illinois 60611.
Insights
Atherosclerosis in the descending thoracic aorta, often undetected, shows plaques with lower echogenicity. Unlike other arteries, these plaques do not cause compensatory increases in total arterial area.
Area of Science:
- Cardiovascular Imaging
- Vascular Biology
- Atherosclerosis Research
Background:
- The in vivo acoustic and structural features of atherosclerosis in the descending thoracic aorta remain incompletely understood.
- Previous studies have not fully characterized plaque morphology and arterial remodeling in this specific aortic segment.
Purpose of the Study:
- To prospectively evaluate the in vivo acoustic and structural characteristics of atherosclerosis in the descending thoracic aorta.
- To investigate plaque prevalence, morphology, echogenicity, and arterial remodeling patterns in this region.
Main Methods:
- Prospective evaluation of 147 patients undergoing transesophageal echocardiography.
- Exclusion of patients with suspected aortic disease.
- Analysis of plaque characteristics (protrusion, mobility, echogenicity) and arterial dimensions (lumen, wall, total area).
Main Results:
- Twenty-six percent of patients had protruding atherosclerotic plaques, with 6 patients exhibiting mobile intimal densities.
- Plaque presence was associated with decreased aortic lumen area and increased wall area (p<0.05).
- Total arterial area did not increase compensatorily, and plaque echogenicity was lower than plaque-free wall regions (p<0.05).
Conclusions:
- Undetected atherosclerotic plaques are common in the descending thoracic aorta, occurring in about a quarter of patients.
- These plaques exhibit lower echogenicity and do not induce compensatory enlargement of the total arterial area.
- The findings suggest that atherosclerotic remodeling in the descending thoracic aorta may differ from other arterial beds.
Abstract:
The in vivo acoustic and structural characteristics of atherosclerosis in the descending thoracic aorta have not been well delineated. We prospectively evaluated the descending thoracic aorta of 147 patients (35 women and 112 men; age, 61 +/- 14 years) who underwent clinically indicated transesophageal echocardiography. Patients with suspected disease of the aorta were excluded. Thirty-eight patients (26%) had protruding plaques (men, 25%; women, 29%). Six patients had mobile intimal densities with the mobile area ranging up to 1 cm2. As expected, aortic lumen area was decreased (plaque-free, 3.53 cm2; plaque, 3.19 cm2; p less than 0.05) and wall area was increased (plaque-free, 1.51 cm2; plaque, 1.92 cm2; p less than 0.05) in the regions of the plaque. However, total arterial area was not increased (plaque-free, 5.04 cm2; plaque, 5.09 cm2; difference not significant) in a compensatory manner as observed in other arterial beds. Plaque gray scale was less than the gray scale of plaque-free wall (plaque-free, 141.2; plaque, 122.7; p less than 0.05) when compared at the same level of the descending thoracic aorta or with a second aortic plaque-free level (plaque-free, 150.4; plaque, 122.7; p less than 0.05). Standard deviation of gray scale level was similar between plaque and normal regions. Unsuspected protruding plaques in the descending thoracic aorta occurred in one quarter of the patients referred for routine transesophageal examination. Plaques tended to have lower echogenicity and were differentiated from plaque-free walls within patients. Plaque formation did not result in increased total arterial area. These data suggest that the degree or character of compensatory atherosclerotic remodeling in the highly elastic descending thoracic aorta may differ from other arterial beds.