Atherosclerosis of the ascending aorta. Prevalence and role as an independent predictor of cerebrovascular events in cardiac patients.
OBJECTIVE
The cause of cerebral and peripheral embolism remains undetermined in a significant number of patients. An atherosclerotic thoracic aorta has thus far been considered to be an uncommon one.


METHODS
To define the potential role of the ascending thoracic aorta as an embolic source, intraoperative ultrasonic aortic imaging was performed in 1200 of 1334 consecutive patients aged 50 years and older who were undergoing cardiac surgery. Patients were divided into two groups according to the results of the ultrasound study in terms of presence or absence of atherosclerotic disease. The prevalence of previous neurological events in the two groups was characterized and compared.


RESULTS
Ascending aortic atherosclerosis was present in 231 (19.3%) of the patients studied. Patients in this category were older (P < .0001). A higher percentage of them were smokers (P < .0001) compared with patients with less severe disease. Coronary artery disease was more extensive (P = .012), and a higher percentage of these patients had a history of peripheral vascular disease (P < .0001). Univariate analysis of the subjects with (n = 158) and without (n = 1042) previous neurological events indicated that age, body mass index, atrial fibrillation, hypertension, and atherosclerosis of the ascending aorta were associated significantly with previous occurrence of a cerebrovascular accident. For the group as a whole, multiple logistic regression analysis demonstrated that hypertension (odds ratio, 1.81; P = .002), atherosclerosis of the ascending aorta (odds ratio, 1.65; P = .013), and atrial fibrillation (odds ratio, 1.54; P = .060) were significantly and independently associated with the occurrence of previous neurological events.


CONCLUSIONS
Atherosclerosis of the ascending aorta is an independent risk factor for cerebrovascular events. An atherosclerotic ascending aorta may represent a potential source of emboli or may be a marker of generalized atherosclerosis.
Dávila-Román
V G
VG
Cardiovascular Division, Washington University, St Louis, MO 63110.
Barzilai
B
B
Wareing
T H
TH
Murphy
S F
SF
Schechtman
K B
KB
Kouchoukos
N T
NT
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D001281:Atrial Fibrillation / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000453:epidemiology*; D003327:Coronary Disease / Q000453:epidemiology / Q000601:surgery; D017700:Embolism, Cholesterol / Q000453:epidemiology; D005260:Female; D005544:Forecasting; D006331:Heart Diseases / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D018084:Ultrasonography, Interventional