Sage Journals: Discover world-class research

Abstract

Background

There is a significant association between aortic atherosclerosis and previous major cardiovascular events. Particularly, thoracic aortic atherosclerosis is closely related to the degree of coronary and carotid artery disease. Thus, there is a rationale for screening the thoracic aorta in patients who undergo a chest computed tomography (CT) for any clinical question, in order to detect patients at increased risk of cerebro-cardiovascular (CCV) events.

Purpose

To estimate the association between either thoracic aortic wall thickness (AWT) or aortic total calcium score (ATCS) and CCV events.

Material and Methods

One hundred and forty-eight non-cardiac patients (78 men; 67±12 years) underwent chest contrast-enhanced multidetector CT (MDCT). The AWT was measured at the level of the left atrium (AWT_ref) and at the maximum AWT (AWT_max). Correlation with clinical CCV patients' history was estimated. The value of AWT_max and of a semi-quantitative ATCS as a marker for CCV events was assessed using receiver-operating characteristic curve (ROC) analysis and multivariate regression analysis.

Results

Out of 148 patients, 59% reported sedentary lifestyle, 44% hypertension, 32% smoking, 23% hypercholesterolemia, 13% family history of cardiac disease, 12% diabetes, and 10% BMI ≥30 kg/m²; 9% reported myocardial infarction, 8% aortic aneurism, 8% myocardial revascularization, and 2% ischemic stroke. Twenty-six percent of patients had a medium-to-high ATCS. Both AWT_max and AWT_ref correlated with hypertension and age (P < 0.002). At the ROC analysis, a 4.8 mm threshold was associated to a 90% specificity and an odds ratio of 6.3 (AUC = 0.735). Assuming as threshold the AWT_max median value (4.3 mm) of patients who suffered from at least one CCV event in their history, a negative predictive value of 90%, a RR of 3.6 and an OR of 6.3 were found. At the multivariate regression analysis, AWT_max was the only independent variable associated to the frequency of CCV events.

Conclusion

Patients with increased thoracic AWT_max on chest MDCT could be considered at risk for CCV disease.

Keywords

Aorta atherosclerosis cardiovascular diseases cerebrovascular insufficiency multidetector computed tomography (MDCT)risk factors

Get full access to this article

View all access options for this article.

References

Libby

. Inflammation in atherosclerosis. Nature 2002; 420: 868–874–868–874.

Naghavi

Libby

Falk E . From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation 2003; 108: 1664–1672–1664–1672.

Rohani

Jogestrand

Ekberg

. Interrelation between the extent of atherosclerosis in the thoracic aorta, carotid intima-media thickness and the extent of coronary artery disease. Atherosclerosis 2005; 179: 311–316–311–316.

Cohen

Tzourio

Bertrand

. Aortic plaque morphology and vascular events: a follow-up study in patients with ischemic stroke. FAPS Investigators. French Study of Aortic Plaques in Stroke. Circulation 1997; 96: 3838–3841–3838–3841.

Agmon

Khandheria

Meissner

. Relation of coronary artery disease and cerebrovascular disease with atherosclerosis of the thoracic aorta in the general population. Am J Cardiol 2002; 89: 262–267–262–267.

Amarenco

Cohen

Tzourio

. Atherosclerotic disease of the aortic arch and the risk of ischemic stroke. N Engl J Med 1994; 331: 1474–1479–1474–1479.

The French Study of Aortic Plaques in Stroke Group. Atherosclerotic disease of the aortic arch as a risk factor for recurrent ischemic stroke. N Engl J Med 1996; 334: 1216–1221–1216–1221.

Kronzon

Tunick

. ortic atherosclerotic disease and stroke. Circulation 2006; 114: 63–75–63–75.

Sardanelli

Di Leo

. Biostatistics for radiologists, Milan: Springer-Verlag, 2009.

10.

Jang

Yong

Doo

. Relation of aortic calcification, wall thickness, and distensibility with severity of coronary artery disease: evaluation with coronary CT. Acta Radiol 2012; 53: 839–844–839–844.

11.

Belhassen

Carville

Pelle

. Evaluation of carotid artery and aortic intima-media thickness measurements for exclusion of significant coronary atherosclerosis in patients scheduled for heart valve surgery. J Am Coll Cardiol 2002; 39: 1139–1144–1139–1144.

12.

Konstadt

Reich

Quintana

. The ascending aorta: how much does transesophageal echocardiography see? Anesth Analg 1994; 78: 240–244–240–244.

13.

Shively

. Transesophageal echocardiography in the diagnosis of aortic disease. Semin Ultrasound CT MR 1993; 14: 106–116–106–116.

14.

Hussain

Gilkeson

Suarez

. Comparing multislice electrocardiogram-gated spiral computerized tomography and transesophageal echocardiography in evaluating aortic atheroma in patients with acute ischemic stroke. J Stroke Cerebrovasc Dis 2008; 17: 134–140–134–140.

15.

Jeltsch

Klass

Klein

. Aortic wall thickness assessed by multidetector computed tomography as a predictor of coronary atherosclerosis. Int J Cardiovasc Imaging 2009; 25: 209–217–209–217.

16.

Meissner

Khandheria

Sheps

. Atherosclerosis of the aorta: risk factor, risk marker, or innocent bystander? A prospective population-based transesophageal echocardiography study. J Am Coll Cardiol 2004; 44: 1018–1024–1018–1024.

17.

Jacobs

Prokop

van der Graaf

. Comparing coronary artery calcium and thoracic aorta calcium for prediction of all-cause mortality and cardiovascular events on low-dose non-gated computed tomography in a high-risk population of heavy smokers. Atherosclerosis 2010; 209: 455–462–455–462.

Association of aortic wall thickness on contrast-enhanced chest CT with major cerebro-cardiac events