title: Thoracic aortic arteriosclerosis in patients with degenerative aortic stenosis with and without coexisting coronary artery disease.
abstract: BACKGROUND
  The association between the severity of arteriosclerosis in the thoracic aorta in patients with isolated aortic stenosis (AS) and with concomitant coronary artery disease (CAD) has been not evaluated. Therefore, the aim of our study was to compare the thoracic aortic atheroma extent and severity in patients with severe AS alone and with concomitant CAD by intraoperative transesophageal echocardiography.
  
  
  METHODS
  We retrospectively evaluated echocardiograms of 105 consecutive patients with severe degenerative AS who underwent aortic valve replacement. Sixty patients had concomitant CAD (AS/CAD) on coronary angiography and 45 had no CAD (AS alone). These patients were compared with 54 sex- and age-matched patients without AS or CAD. Aortic atheroma (localized intimal thickening of >3 mm) prevalence and morphology in three segments of aorta were assessed with echocardiography.
  
  
  RESULTS
  There were 62 men, mean age 75.3 +/- 9.4 years. No difference was observed in age, sex, and risk factors for arteriosclerosis other than hypercholesterolemia among AS/CAD, AS alone, and control groups (88%, 67%, 41%, respectively; p < 0.0001). The AS/CAD group had a significantly higher rate of aortic root calcification (68%, 36%, 26%, respectively; p < 0.0001) and aortic atheroma (ascending aorta [26%, 20%, 14%, respectively; p = 0.03]; aortic arch [78%, 36%, 30%, respectively; p < 0.0001]; descending aorta [72%, 42%, 29%, respectively; p < 0.0001]) than AS alone or control subjects. Patients with AS/CAD also had more complex atheromas in the aortic arch (48%, 20%, 7%, respectively; p < 0.0001). Significant differences in extension of aortic arteriosclerosis (presence of plaques in two or three segments) were observed among the groups (70%, 31%, 18%, respectively; p < 0.0001).
  
  
  CONCLUSIONS
  Patients with severe AS and coexisting CAD have more extensive arteriosclerotic changes in the thoracic aorta compared with those with AS alone and control subjects. Preoperative evaluation of the thoracic aorta and more aggressive lipid therapy should be considered in these patients.
authors.affiliation: Division of Cardiology, Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
authors.forename: Sorel
authors.initials: S
authors.lastname: Goland
authors.forename: Alfredo
authors.initials: A
authors.lastname: Trento
authors.forename: Lawrence S C
authors.initials: LS
authors.lastname: Czer
authors.forename: Shervin
authors.initials: S
authors.lastname: Eshaghian
authors.forename: Kirsten
authors.initials: K
authors.lastname: Tolstrup
authors.forename: Tasneem Z
authors.initials: TZ
authors.lastname: Naqvi
authors.forename: Michele A
authors.initials: MA
authors.lastname: De Robertis
authors.forename: James
authors.initials: J
authors.lastname: Mirocha
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Iida
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000601:surgery*; D001161:Arteriosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D016022:Case-Control Studies; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution