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High risk for vascular events in patients with protruding aortic atheromas: a prospective study
P A Tunick1, B P Rosenzweig, E S Katz
1Charles and Rose Wholstetter Noninvasive Cardiology Laboratory, Department of Medicine, New York University Medical Center, New York.
Insights
Protruding aortic atheromas detected by transesophageal echocardiography significantly increase the risk of future vascular events. This finding highlights the predictive value of these atheromas for embolic disease.
Area of Science:
- Cardiovascular Medicine
- Diagnostic Imaging
- Vascular Surgery
Background:
- Protruding atheromas in the thoracic aorta are linked to embolic disease.
- Previous research relied on retrospective studies.
Purpose of the Study:
- To prospectively assess the risk of vascular events in patients with protruding aortic atheromas.
- To determine if protruding atheromas independently predict vascular events.
Main Methods:
- Transesophageal echocardiography was performed on 521 patients over 1 year.
- 42 patients with protruding atheromas and no other emboli source were followed for up to 2 years.
- A control group without atheromas, matched for age, gender, and hypertension, was used for comparison.
Main Results:
- 14 out of 42 patients (33%) with atheromas experienced vascular events, compared to 3 out of 42 controls (7%).
- Protruding atheromas were the only significant predictor of events in univariate and multivariate analyses (OR 4.3, p=0.005).
- No correlation was found with age, gender, hypertension, smoking, or other common risk factors.
Conclusions:
- Protruding atheromas identified via transesophageal echocardiography are significant predictors of future vascular events.
- This study provides prospective evidence supporting the clinical significance of aortic atheromas.
Objectives:
The purpose of this study was to prospectively evaluate the risk of vascular events in patients with protruding aortic atheromas.
Background:
Protruding atheromas of the thoracic aorta have been shown to be associated with embolic disease in previous retrospective studies.
Methods:
During a 1-year period, 521 patients had transesophageal echocardiography. Of these, 42 patients had protruding atheromas and no other source of emboli. They were followed up for up to 2 years (mean follow-up 14 months) and compared with a control group without atheromas, matched for age, gender and hypertension.
Results:
Of 42 patients with atheromas, 14 (33%) had 19 vascular events during follow-up (5 brain, 2 eye, 4 kidney, 1 bowel, 7 lower extremity). Of 42 control patients, 3 (7%) had vascular events (2 brain, 1 eye). Univariate analysis identified only protruding atheromas as significantly correlating with events (p = 0.003). There was no positive correlation of events with age, gender, hypertension, smoking, family history, atrial fibrillation, valve replacement, antithrombotic drug use, diabetes or coronary disease. Multivariate analysis showed that only protruding atheromas independently predicted events (p = 0.005, odds ratio 4.3, 95% confidence interval 1.2 to 15.0). Nine patients died in the atheroma group versus six in the control group, but this was not statistically significant (p = 0.39).
Conclusions:
Protruding atheromas seen on transesophageal echocardiography predict future vascular events.