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Aortic calcifications on routine preoperative chest X-ray and perioperative stroke during cardiac surgery: a nested
Wiebe G Knol1,2, Ad J J C Bogers1, Loes M M Braun2
1Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands.
Insights
Preoperative chest X-rays (CXRs) showing aortic calcifications did not predict embolic stroke risk in cardiac surgery patients. Aortic calcification burden on CXR was similar in stroke cases and controls, suggesting CXR is not a reliable tool for stroke risk assessment.
Area of Science:
- Cardiovascular Surgery
- Neurology
- Radiology
Background:
- Perioperative stroke in cardiac surgery is frequently embolic.
- Aortic calcification is a potential source of emboli.
- Preoperative chest X-ray (CXR) is used to screen for aortic calcification.
Purpose of the Study:
- To investigate the association between aortic calcifications on CXR and perioperative embolic stroke.
- To determine if CXR findings can predict stroke risk in cardiac surgery.
Main Methods:
- A nested matched case-control study was conducted.
- Patients undergoing cardiac surgery between 2014 and 2017 were analyzed.
- Preoperative CXRs were scored for aortic calcifications; cases had stroke, controls did not.
Main Results:
- 27 stroke cases and 78 controls were identified from 3038 patients.
- Aortic calcifications were most frequent in the aortic knob (63%) and least in the ascending aorta (9%).
- The distribution and burden of aortic calcification were comparable between stroke cases and controls.
Conclusions:
- Aortic calcification burden on preoperative CXR was not associated with embolic stroke risk.
- CXR findings for aortic calcification are not a reliable predictor of stroke risk in this population.
- The correlation between CXR findings and stroke risk may be too weak for direct assessment of ascending aorta manipulation safety.
Objectives:
Perioperative stroke in cardiac surgery is most often embolic in origin. Preoperative chest X-ray (CXR) is routinely used amongst others to screen for relevant aortic calcification, a potential source of embolic stroke. We performed a nested matched case-control study to examine the relationship between aortic calcifications on CXR and the occurrence of embolic stroke.
Methods:
Among all consecutive patients undergoing cardiac surgery in our hospital between January 2014 and July 2017, we selected all patients with perioperative embolic stroke (cases). Controls, all patients without perioperative stroke, were matched on age, sex and type of surgery. All preoperative CXRs were scored for aortic calcifications (none, mild, severe) in the ascending aorta, arch, aortic knob and descending aorta.
Results:
Out of the 3038 eligible patients, 27 cases were detected and 78 controls were selected. In the stroke group, mild-to-severe calcifications were found least often in the ascending aorta [9% of patients, 95% confidence interval (CI) 1-29%] and most frequently in the aortic knob (63% of patients, 95% CI 44-78%). The distribution of aortic calcification was comparable in cases versus controls.
Conclusions:
Calcification burden was comparable between the cases and their matched controls. In our study population, CXR findings on aortic calcification were not related to the risk of embolic stroke. In these patients, the correlation between findings on the preoperative CXR and the risk of stroke might, therefore, be too weak to use the CXR directly for the assessment of the safety of manipulating the ascending aorta during surgery.
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