[Evaluation of aortic atherosclerosis by transesophageal echocardiography. Prognostic implications]

A recent anatomical study has reported a relationship between the presence of ulcerated atheromatous plaque of the aortic arch and cerebral infarction. Several studies using transoesophageal echocardiography have established that atherothrombosis of the ascending and proximal is a potential source of systemic embolism. We have shown that aortic plaques > or = 4 mm in thickness increase the risk of cerebral infarction by 9. Several studies have shown that this localisation of atherosclerosis was also a powerful marker of general vascular risk. In the multicenter FAPS (French Study of Aortic Plaque in Stroke) trial, the authors followed up 331 patients who had suffered cerebral infarction, aged over 60 years, for a mean duration of 2.4 years. The occurrence rate of cerebral infarction and the incidence of cardiovascular complications (death, myocardial infarction, cerebral infarction, systemic embolism) was respectively 11.9% and 26% per year. The presence of plaques with thickness greater or equal to 4 mm was associated with an adjusted relative risk of 3.8 (95% confidence interval, 1.8 to 7.8) and 3.5 (95% confidence interval, 3.1 to 5.9) respectively. The influence of plaque morphology (thrombus, irregularity, absence of calcification), independently of its thickness, also seems to affect the prognosis. In this study, as in those reported by other groups, the influence of anti-thrombotic therapy was not specifically addressed. The definition of high risk plaques (thickness, irregularity, thrombus) could be useful in the evaluation of therapy which affects the atherosclerotic process (antiplatelet agents, anticoagulants, statins). We conclude that atherosclerosis of the ascending aorta and aortic arch is a potential source of systemic embolism and a powerful marker of overall vascular risk.