title: Impact of aortic arch stiffness on recurrence of stroke in patients with acute ischemic stroke.
abstract: BACKGROUND
  Aortic arch plaques are associated with increased risk of stroke recurrence. The atherosclerotic process also affects aortic stiffness. The purpose of the present study was to evaluate aortic arch stiffness by transesophageal echocardiography (TEE) and its effect on recurrence of stroke.
  
  
  RESULTS
  TEE was performed in 201 patients with stroke and the aortic stiffness parameter beta was measured as an expression of the elasticity of the aortic arch wall. Patients were followed during a median follow-up period of 459 days with the endpoint as stroke recurrence. There were 21 cases of stroke recurrence (10%) during the follow-up period and the stiffness parameter beta was significantly higher in those cases (16.8+/-4.6 vs 12.5+/-3.3 [no recurrence], p<0.01). Cox multivariate hazard analysis revealed that stiffness parameter beta was the only independent predictor for stroke recurrence (hazard ratio 1.683, p<0.01). Kaplan-Meier survival analysis revealed that stiffness parameter beta effectively risk stratified patients for stoke recurrence. Furthermore, in 3 groups based on the value of beta, the 3rd tertile had the highest stroke recurrent risk (relative risk 5.473, p<0.01).
  
  
  CONCLUSIONS
  The value of beta in the aortic arch, assessed by TEE, may be a sensitive indicator of stroke recurrence.
authors.affiliation: Department of Cardiology, Yamagata University School of Medicine, Yamagata, Japan. hiokuyama-circ@umin.net
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Okuyama
authors.forename: Osamu
authors.initials: O
authors.lastname: Hirono
authors.forename: Harutoshi
authors.initials: H
authors.lastname: Tamura
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nishiyama
authors.forename: Yasuchika
authors.initials: Y
authors.lastname: Takeishi
authors.forename: Takamasa
authors.initials: T
authors.lastname: Kayama
authors.forename: Isao
authors.initials: I
authors.lastname: Kubota
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000503:physiopathology*; D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D002545:Brain Ischemia / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D017548:Echocardiography, Transesophageal; D004548:Elasticity; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D013997:Time Factors