title: Relation of aortic arch complex plaques to risk of cerebral infarction in patients with aortic stenosis.
abstract: Aortic stenosis (AS) and systemic atherosclerosis have been shown to be closely related. We evaluated the prevalence of aortic arch plaques and their possible association with the risk of cerebral infarction in patients with severe AS. Transesophageal echocardiography was performed in 116 patients with severe AS (55 men, mean age 71 ± 7 years, mean aortic valve area 0.68 ± 0.15 cm(2)) who were scheduled for aortic valve replacement. The presence, thickness, and morphology of the aortic arch plaques were evaluated using transesophageal echocardiography. Cerebral infarcts (chronic cerebral infarction and cerebral infarction after cardiac catheterization and aortic valve replacement) were assessed in all patients. Compared to age- and gender-matched control subjects, the patients with severe AS had a significantly greater prevalence of aortic arch plaques (74% vs 41%; p <0.0001) and complex arch plaques such as large plaques (≥4 mm), ulcerated plaques, or mobile plaques (30% vs 10%; p = 0.004). Multivariate logistic analyses showed that the presence of complex arch plaques was independently associated with cerebral infarction in patients with AS after adjusting for traditional atherosclerotic risk factors and coronary artery disease (odds ratio 8.46, 95% confidence interval 2.38 to 30.12; p = 0.001). In conclusion, the results from the present study showed that there is a greater prevalence of aortic arch plaques in patients with AS and that the presence of complex plaques is independently associated with cerebral infarction in these patients. Therefore, the identification of complex arch plaques using transesophageal echocardiography is important for risk stratification of cerebrovascular events in patients with severe AS.
authors.affiliation: Department of Internal Medicine and Cardiology, Osaka City University Graduate School of Medicine, Japan. k-sugioka@med.osaka-cu.ac.jp
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugioka
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Matsumura
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hozumi
authors.forename: Suwako
authors.initials: S
authors.lastname: Fujita
authors.forename: Asahiro
authors.initials: A
authors.lastname: Ito
authors.forename: Toru
authors.initials: T
authors.lastname: Kataoka
authors.forename: Masahiko
authors.initials: M
authors.lastname: Takagi
authors.forename: Kazuki
authors.initials: K
authors.lastname: Mizutani
authors.forename: Takahiko
authors.initials: T
authors.lastname: Naruko
authors.forename: Mitsuharu
authors.initials: M
authors.lastname: Hosono
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Hirai
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Makiko
authors.initials: M
authors.lastname: Ueda
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Suehiro
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoshiyama
mesh_terms: D000368:Aged; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D002544:Cerebral Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D017548:Echocardiography, Transesophageal / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000000981:diagnostic imaging / Q000453:epidemiology; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors