title: Impact of concomitant coronary artery disease on atherosclerotic plaques in the aortic arch in patients with severe aortic stenosis.
abstract: BACKGROUND
  Coronary artery disease (CAD) often occurs concurrently in patients with severe aortic stenosis (AS). However, the influence of concomitant CAD on the presence of atherosclerotic complex plaques in the aortic arch, which is associated with increased stroke risk, has not been fully assessed in patients with severe AS.
  
  
  OBJECTIVE
  We hypothesized that concomitant CAD would be associated with the presence of complex arch plaques in patients with severe AS.
  
  
  METHODS
  The study population consisted of 154 patients with severe AS who had undergone transesophageal echocardiography (TEE) and coronary angiography (71 male; mean age, 72 ± 8 years; mean aortic valve area, 0.67 ± 0.15 cm(2) ). Aortic arch plaques were assessed using TEE, and complex arch plaques were defined as large plaques (≥4 mm), ulcerated plaques, or mobile plaques.
  
  
  RESULTS
  The prevalence of aortic arch plaques (87% vs 70%; P = 0.03) and complex arch plaques (48% vs 20%; P < 0.001) was significantly greater in AS patients with CAD than in those without CAD. After adjustment for traditional atherosclerotic risk factors, we found that concomitant CAD was independently associated with the presence of complex arch plaques (odds ratio: 2.86, 95% confidence interval: 1.23-6.68, P = 0.01).
  
  
  CONCLUSIONS
  In patients with severe AS, concomitant CAD is associated with severe atherosclerotic burden in the aortic arch. This observation suggests that AS patients with concomitant CAD are at a higher risk for stroke, and that careful evaluation of complex arch plaques by TEE is needed for the risk stratification of stroke in these patients.
authors.affiliation: Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan.
authors.forename: Suwako
authors.initials: S
authors.lastname: Fujita
authors.forename: Kenichi
authors.initials: K
authors.lastname: Sugioka
authors.forename: Yoshiki
authors.initials: Y
authors.lastname: Matsumura
authors.forename: Asahiro
authors.initials: A
authors.lastname: Ito
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hozumi
authors.forename: Takao
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Akihisa
authors.initials: A
authors.lastname: Hanatani
authors.forename: Takahiko
authors.initials: T
authors.lastname: Naruko
authors.forename: Makiko
authors.initials: M
authors.lastname: Ueda
authors.forename: Minoru
authors.initials: M
authors.lastname: Yoshiyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D001018:Aortic Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000000981:diagnostic imaging; D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D020521:Stroke / Q000209:etiology