Atherosclerosis of the ascending aorta is an independent predictor of long-term neurologic events and mortality.
OBJECTIVE
This study was undertaken to determine whether atherosclerosis of the ascending aorta is a predictor of long-term neurologic events and mortality.


BACKGROUND
Atherosclerosis of the thoracic aorta has been recently considered a significant predictor of neurologic events and peripheral embolism, but not of long-term mortality.


METHODS
Long-term follow-up (a total of 5,859 person-years) was conducted of 1,957 consecutive patients > or =50 years old who underwent cardiac surgery. Atherosclerosis of the ascending aorta was assessed intraoperatively (epiaortic ultrasound) and patients were divided into four groups according to severity (normal, mild, moderate or severe). Carotid artery disease was evaluated (carotid ultrasound) in 1,467 (75%) patients. Cox proportional-hazards regression analysis was performed to assess the independent effect of predictors on neurologic events and mortality.


RESULTS
A total of 491 events occurred in 472 patients (neurologic events 92, all-cause mortality 399). Independent predictors of long-term neurologic events were: hypertension (p = 0.009), ascending aorta atherosclerosis (p = 0.011) and diabetes mellitus (p = 0.015). The independent predictors of mortality were advanced age (p < 0.0001), left ventricular dysfunction (p < 0.0001), ascending aorta atherosclerosis (p < 0.0001), hypertension (p = 0.0001) and diabetes mellitus (p = 0.0002). There was >1.5-fold increase in the incidence of both neurologic events and mortality as the severity of atherosclerosis increased from normal-mild to moderate, and a greater than threefold increase in the incidence of both as the severity of atherosclerosis increased from normal-mild to severe.


CONCLUSIONS
Atherosclerosis of the ascending aorta is an independent predictor of long-term neurologic events and mortality. These results provide additional evidence that in addition to being a direct cause of cerebral atheroembolism, an atherosclerotic ascending aorta may be a marker of generalized atherosclerosis and thus of increased morbidity and mortality.
Dávila-Román
V G
VG
Department of Internal Medicine, Washington University School of Medicine, and Barnes-Jewish Hospital, BJC Health System, St. Louis, Missouri, USA. vdavila@imgate.wustl.edu
Murphy
S F
SF
Nickerson
N J
NJ
Kouchoukos
N T
NT
Schechtman
K B
KB
Barzilai
B
B
D000368:Aged; D000369:Aged, 80 and over; D001011:Aorta; D001018:Aortic Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D001161:Arteriosclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D018616:Ultrasonography, Doppler, Duplex; D014656:Vascular Surgical Procedures