Impact of aortic stiffness on ischemic stroke in elderly patients.
OBJECTIVE
Large atherosclerotic plaques in the aortic arch detected by transesophageal echocardiography (TEE) are associated with increased risk of ischemic stroke in the elderly. The atherosclerotic process also affects aortic distensibility, which can also be assessed by TEE. The purpose of this study was to evaluate the possible association of aortic stiffness by TEE with ischemic stroke in elderly patients.


METHODS
We performed TEE in 40 consecutive elderly patients aged > or =55 years with acute ischemic stroke and in 42 consecutive control subjects aged > or =55 years. Aortic stiffness index beta, which has been used in the literature to express the stiffness of the aortic wall, was calculated as follows: beta=ln (systolic blood pressure/diastolic blood pressure)/([D(max)-D(min)]/D(min)), where ln is natural logarithm, D(max) is maximum aortic lumen diameter, and D(min) is minimum aortic lumen diameter by TEE. The association of index beta with ischemic stroke was evaluated by logistic regression analysis after adjustment for potential confounders, including thickness of aortic arch plaques.


RESULTS
Index beta was significantly greater in stroke patients than in controls (9.7+/-5.0 versus 5.3+/-3.5; P<0.0001). When aortic plaque thickness and other stroke risk factors were entered in multivariate analysis, index beta was found to be independently associated with ischemic stroke (odds ratio, 1.28 per unit increase; 95% CI, 1.10 to 1.52).


CONCLUSIONS
Aortic stiffness by TEE is associated with ischemic stroke, independent of thickness of aortic arch plaques and other stroke risk factors. This suggests that aortic stiffness by TEE may add prognostic information when assessing the risk of ischemic stroke in the elderly.
Sugioka
Kenichi
K
Department of Medicine, Columbia-Presbyterian Medical Center, New York, NY 10032, USA.
Hozumi
Takeshi
T
Sciacca
Robert R
RR
Miyake
Yumiko
Y
Titova
Inna
I
Gaspard
Gabrielle
G
Sacco
Ralph L
RL
Homma
Shunichi
S
Di Tullio
Marco R
MR
D000208:Acute Disease; D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology; D001018:Aortic Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D001161:Arteriosclerosis / Q000150:complications / Q000000981:diagnostic imaging*; D001794:Blood Pressure; D002545:Brain Ischemia / Q000209:etiology / Q000503:physiopathology*; D003971:Diastole; D018450:Disease Progression; D017548:Echocardiography, Transesophageal; D004548:Elasticity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012307:Risk Factors; D020521:Stroke / Q000209:etiology / Q000503:physiopathology* / Q000517:prevention & control; D014654:Vascular Patency; D014741:Video Recording