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Proximal aortic atheroma. An independent risk factor for cerebral ischemia
E F Jones1, J M Kalman, P Calafiore
1Department of Cardiology, Austin Hospital, Heidelberg, Victoria, Australia.
Insights
Atheroma in the ascending aorta and aortic arch is a significant independent risk factor for cerebral ischemia. Transesophageal echocardiography can detect this aortic condition, aiding in stroke risk assessment.
Area of Science:
- Cardiovascular Medicine
- Neurology
- Diagnostic Imaging
Background:
- Transesophageal echocardiography (TEE) often reveals aortic atheroma in patients experiencing cerebral and peripheral emboli.
- Atherosclerotic plaques in the aorta are a potential source of embolic events leading to stroke.
Purpose of the Study:
- To investigate whether atheroma in the ascending aorta and aortic arch independently predicts cerebral ischemia.
- To establish aortic atheroma as a novel risk factor for stroke.
Main Methods:
- A case-control study involving 215 patients with first ischemic stroke/transient ischemic attack and 202 community controls.
- Transesophageal echocardiography was used to identify aortic atheroma and cardiac sources of embolism.
- Logistic regression analysis determined adjusted odds ratios for stroke risk factors, including carotid stenosis.
Main Results:
- Ascending aorta and aortic arch atheroma was a significant, independent risk factor for cerebral ischemia.
- The odds ratio for simple atheroma was 2.3 (95% CI, 1.2–4.2); for complex atheroma, it was 7.1 (95% CI, 2.7–18.4).
- This association remained significant even after accounting for other stroke risk factors like carotid stenosis.
Conclusions:
- Aortic atheroma, particularly in the ascending aorta and arch, is a newly identified independent risk factor for cerebral ischemia.
- Transesophageal echocardiography is crucial for detecting this atheroma and assessing stroke risk.
- Further research is needed to characterize atheroma's embolic potential and optimize management strategies.
Background And Purpose:
Transesophageal echocardiography frequently demonstrates aortic atheroma in patients with cerebral and peripheral emboli. The aim of this study was to determine whether atheroma in the ascending aorta and arch is an independent risk factor for cerebral ischemia.
Methods:
We studied 215 consecutive patients with a first stroke or transient ischemic attack and 202 community-based control subjects using transesophageal echocardiography to detect aortic atheroma and potential cardiac sources for embolism. Information about other stroke risk factors was obtained from a structured interview, and the presence of carotid vascular disease was assessed by means of duplex ultrasonography or digital subtraction angiography. Multiple logistic regression analysis was used to determine adjusted odds ratios for each risk factor.
Results:
Atheroma in the ascending aorta and aortic arch was a significant risk factor for cerebral ischemia, independent of other well-established risk factors including high-grade carotid stenosis. The odds ratio for simple atheroma was 2.3 (95% confidence interval, 1.2 to 4.2) and for complex atheroma 7.1 (2.7 to 18.4).
Conclusions:
Ascending aortic and arch atheroma detected by transesophageal echocardiography is an important new independent risk factor for cerebral ischemia. Further characterization of the embolic potential of atheroma with different echocardiographic appearances and development of optimal management strategies are now needed.