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Echocardiographic evaluation of aortic atheromas in patients with aortic stenosis
Enrico Vizzardi1, Antonio D'Aloia2, Edoardo Sciatti2
1From the Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy (E.V., A.D., E.S., I.B., M.M.); Heart and Vessels Department, Careggi Hospital, Florence, Italy (S.G.); and Experimental Cardiac Surgery Laboratory, Cardiac Surgery Unit, Civil Hospital, Brescia, Italy (R.L.). enrico.vizzardi@tin.it.
Insights
Patients with moderate to severe aortic stenosis have more extensive aortic atheromas. This study used transesophageal echocardiography to assess thoracic aortic atheromas in patients with varying degrees of aortic stenosis.
Area of Science:
- Cardiovascular Medicine
- Radiology
- Pathology
Background:
- Aortic stenosis and aortic atheromas share similar pathogenic mechanisms.
- The association between aortic stenosis and aortic atheromas is increasingly recognized.
Purpose of the Study:
- To evaluate the extent and severity of thoracic aortic atheromas in patients with different grades of aortic stenosis.
- To correlate aortic atheroma characteristics with aortic stenosis severity using transesophageal echocardiography.
Main Methods:
- Retrospective analysis of 686 patients with aortic stenosis undergoing transesophageal echocardiography.
- Assessment of atheroma prevalence, morphology, and plaque thickness in three thoracic aorta segments.
- Grading of atheromas (mild, moderate, severe) and aortic stenosis (mild, moderate, severe) based on established criteria.
Main Results:
- 86% of patients exhibited aortic atheromas, with higher prevalence (95%) in severe stenosis compared to mild stenosis (40%).
- Severe stenosis patients presented with more complex atheromas (52% vs. 22%).
- Moderate and severe stenosis groups showed significantly more moderate and severe atheromas than the mild stenosis group.
Conclusions:
- A significant correlation exists between the extent of aortic atheromas and the degree of aortic stenosis.
- Patients with moderate and severe aortic stenosis demonstrate more widespread atherosclerotic atheromas compared to those with mild stenosis.
Objectives:
The association of aortic atheromas in patients with isolated aortic stenosis has recently been acknowledged, probably because the pathogenic mechanisms are similar. Therefore, this study evaluated the extent and severity of thoracic aortic atheromas in patients with different grades of aortic stenosis using transesophageal echocardiography.
Methods:
We retrospectively evaluated transesophageal echocardiographic examinations of 686 consecutive patients with a diagnosis of aortic stenosis. The prevalence and morphologic characteristics of atheromas in 3 segments of the thoracic aorta were assessed. Plaque thickness was measured at each segment, and the thickest plaque was used to establish severity. Atheromas were graded as mild, moderate, or severe according to plaque thickness (<2, 2-4, or >4 mm, respectively). Aortic stenosis was graded as mild, moderate, or severe on the basis of the gradient and anatomic aortic valve area (>1.5, 1.0-1.5, or <1.0 cm(2)).
Results:
A total of 382 patients were men, and 304 were women (mean age ± SD, 74 ± 15 years); 86% of the patients had aortic atheromas. The severe stenosis group had a significantly higher rate of atheromas (95% versus 40%; P < .001) than the mild stenosis group, with more complex atheromas (52% versus 22%; P< .001). There was no significant difference in the atheroma grades between the severe and moderate stenosis groups, but moderate cases had more moderate and severe atheromas than mild cases (45% and 15% versus 19% and 3%; P < .01).
Conclusions:
This study showed a correlation in the extent of aortic atheromas across several degrees of aortic stenosis. Patients with moderate and severe stenosis had more extensive atherosclerotic atheromas than those with mild stenosis.
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