title: Echocardiographic evaluation of aortic atheromas in patients with aortic stenosis.
abstract: OBJECTIVE
  The association of aortic atheromas in patients with isolated aortic stenosis has recently been acknowledged, probably because the pathogenic mechanisms are similar. Therefore, this study evaluated the extent and severity of thoracic aortic atheromas in patients with different grades of aortic stenosis using transesophageal echocardiography.
  
  
  METHODS
  We retrospectively evaluated transesophageal echocardiographic examinations of 686 consecutive patients with a diagnosis of aortic stenosis. The prevalence and morphologic characteristics of atheromas in 3 segments of the thoracic aorta were assessed. Plaque thickness was measured at each segment, and the thickest plaque was used to establish severity. Atheromas were graded as mild, moderate, or severe according to plaque thickness (<2, 2-4, or >4 mm, respectively). Aortic stenosis was graded as mild, moderate, or severe on the basis of the gradient and anatomic aortic valve area (>1.5, 1.0-1.5, or <1.0 cm(2)).
  
  
  RESULTS
  A total of 382 patients were men, and 304 were women (mean age ± SD, 74 ± 15 years); 86% of the patients had aortic atheromas. The severe stenosis group had a significantly higher rate of atheromas (95% versus 40%; P < .001) than the mild stenosis group, with more complex atheromas (52% versus 22%; P< .001). There was no significant difference in the atheroma grades between the severe and moderate stenosis groups, but moderate cases had more moderate and severe atheromas than mild cases (45% and 15% versus 19% and 3%; P < .01).
  
  
  CONCLUSIONS
  This study showed a correlation in the extent of aortic atheromas across several degrees of aortic stenosis. Patients with moderate and severe stenosis had more extensive atherosclerotic atheromas than those with mild stenosis.
authors.affiliation: From the Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy (E.V., A.D., E.S., I.B., M.M.); Heart and Vessels Department, Careggi Hospital, Florence, Italy (S.G.); and Experimental Cardiac Surgery Laboratory, Cardiac Surgery Unit, Civil Hospital, Brescia, Italy (R.L.). enrico.vizzardi@tin.it.
authors.forename: Enrico
authors.initials: E
authors.lastname: Vizzardi
authors.affiliation: From the Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy (E.V., A.D., E.S., I.B., M.M.); Heart and Vessels Department, Careggi Hospital, Florence, Italy (S.G.); and Experimental Cardiac Surgery Laboratory, Cardiac Surgery Unit, Civil Hospital, Brescia, Italy (R.L.).
authors.forename: Antonio
authors.initials: A
authors.lastname: D'Aloia
authors.affiliation: From the Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy (E.V., A.D., E.S., I.B., M.M.); Heart and Vessels Department, Careggi Hospital, Florence, Italy (S.G.); and Experimental Cardiac Surgery Laboratory, Cardiac Surgery Unit, Civil Hospital, Brescia, Italy (R.L.).
authors.forename: Edoardo
authors.initials: E
authors.lastname: Sciatti
authors.affiliation: From the Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy (E.V., A.D., E.S., I.B., M.M.); Heart and Vessels Department, Careggi Hospital, Florence, Italy (S.G.); and Experimental Cardiac Surgery Laboratory, Cardiac Surgery Unit, Civil Hospital, Brescia, Italy (R.L.).
authors.forename: Ivano
authors.initials: I
authors.lastname: Bonadei
authors.affiliation: From the Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy (E.V., A.D., E.S., I.B., M.M.); Heart and Vessels Department, Careggi Hospital, Florence, Italy (S.G.); and Experimental Cardiac Surgery Laboratory, Cardiac Surgery Unit, Civil Hospital, Brescia, Italy (R.L.).
authors.forename: Sandro
authors.initials: S
authors.lastname: Gelsomino
authors.affiliation: From the Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy (E.V., A.D., E.S., I.B., M.M.); Heart and Vessels Department, Careggi Hospital, Florence, Italy (S.G.); and Experimental Cardiac Surgery Laboratory, Cardiac Surgery Unit, Civil Hospital, Brescia, Italy (R.L.).
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.affiliation: From the Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy (E.V., A.D., E.S., I.B., M.M.); Heart and Vessels Department, Careggi Hospital, Florence, Italy (S.G.); and Experimental Cardiac Surgery Laboratory, Cardiac Surgery Unit, Civil Hospital, Brescia, Italy (R.L.).
authors.forename: Marco
authors.initials: M
authors.lastname: Metra
mesh_terms: D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging*; D001024:Aortic Valve Stenosis / Q000150:complications*; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: aortic atheroma; aortic stenosis; atherosclerosis; transesophageal echocardiography; vascular ultrasound