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Atherosclerotic plaque evolution in the descending thoracic aorta in familial hypercholesterolemic patients. A
C J Herrera1, L J Frazin, P C Dau
1Department of Medicine, Evanston Hospital, Ill.
Insights
Transesophageal echocardiography effectively visualizes atherosclerotic plaque in familial hypercholesterolemic patients. LDL apheresis therapy reduced plaque-to-wall ratio, indicating treatment efficacy.
Area of Science:
- Cardiovascular Medicine
- Medical Imaging
- Atherosclerosis Research
Background:
- Familial hypercholesterolemia (FH) is a genetic disorder leading to high LDL cholesterol and premature atherosclerosis.
- Atherosclerotic plaque in the descending thoracic aorta is a significant risk factor for cardiovascular events.
- Non-invasive imaging techniques are crucial for monitoring plaque progression and treatment response in FH patients.
Purpose of the Study:
- To evaluate transesophageal echocardiography (TEE) as a tool for detecting and characterizing atherosclerotic plaque in the descending thoracic aorta of FH patients.
- To analyze the evolution of plaque morphology and characteristics in response to different therapeutic interventions.
- To assess the impact of LDL apheresis on plaque burden and arterial remodeling.
Main Methods:
- A prospective, randomized study involving eight FH patients (mean age 42 years) receiving either standard therapy or LDL apheresis.
- Baseline and 12-month follow-up transesophageal echocardiography (TEE) examinations were performed.
- Key measurements included atherosclerotic plaque area (PA), aortic wall area (WA), total arterial area (TAA), and plaque-to-wall area ratio (PWR).
Main Results:
- The most severe atherosclerotic plaques were observed between 30-35 cm from the incisors, with smaller plaques at the aortic arch and distal aorta.
- In the control group, total arterial area, plaque area, and plaque-to-wall ratio showed no significant changes.
- The LDL apheresis group demonstrated an increase in total arterial area (P < .05) and a significant decrease in plaque-to-wall ratio (P < .05), with plaque area decreasing in 3 of 5 patients.
Conclusions:
- Transesophageal echocardiography is a viable method for assessing atherosclerotic plaque in the descending thoracic aorta in FH patients.
- LDL apheresis therapy can lead to favorable changes in aortic plaque characteristics, including a reduced plaque-to-wall ratio.
- Further research is warranted to explore the long-term impact of TEE-guided therapies on cardiovascular outcomes in FH.
Abstract:
We explored the concept that transesophageal echocardiography can be used as a tool to detect, characterize, and study plaque morphology in the descending thoracic aorta. The pattern of atherosclerotic plaques in the descending thoracic aorta in familial hypercholesterolemic (FH) patients was evaluated. Additionally, evolution of plaque characteristics as a result of therapy was analyzed. In a randomized prospective protocol, eight FH patients (five men and three women, aged 23 to 65 years [mean +/- SD, 42 +/- 14 years]) receiving standard therapy (n = 3; baseline low-density lipoprotein [LDL] cholesterol, 222 +/- 71 mg/dL, mean +/- SD) or LDL apheresis (n = 5; baseline LDL cholesterol, 262 +/- 51 mg/dL) were studied. Baseline and follow-up (mean, 12 months) transesophageal echocardiographic studies were performed. Measurements obtained were atherosclerotic plaque area (PA), aortic wall area (WA), total arterial area (TAA), and plaque-to-wall area ratio (PWR). LDL cholesterol decreased in both groups. The greatest severity of plaque was detected at 30 to 35 cm from the incisors (approximately 15 to 20 cm from the aortic arch). The smallest plaques were present at the arch and more distal descending aorta. In the control group, TAA, PA, and PWR did not change significantly (P = NS versus baseline). In the LDL-apheresis group, TAA increased (P < .05 versus baseline), PA decreased in three of five patients (P = NS versus baseline), and PWR fell (P < .05 versus baseline).(ABSTRACT TRUNCATED AT 250 WORDS)