Atheromatosis of the Thoracic Aorta as Predictor of Cardiovascular Mortality and Cerebrovascular and Coronary Events

Héctor Alfredo Deschle, Pablo Oberti, Jorge Lowenstein, Carlos Rodríguez Correa, Gastón Lanternier, Salvador Spina, Mariano Falconi, Eduardo Guevara, Silvia Makhoul, María Elena Adaniya



To evaluate the severity of atheromatosis of the thoracic aorta and its relation with mortality and cerebrovascular and coronary events.

Material and Methods

Between 2005 and 2007, 601 patients (ps) were referred for evaluation with transesophageal echocardiography (TEE).

Age: 64.53±13.61 years

Male gender: 337ps.

The following variables were included:

Reason for ordering the study: embolic source (37.7%), endocarditis (22.1%), previous to cardioversion (11.5%), mitral valve disease (9.8%), other reasons (18.95%). Risk factors: diabetes, smoking habits, hypertension, dyslipidemia. Presence of atrial fibrillation. 

The patients were divided into two groups:

With uncomplicated aortic plaques < 4 mm: ps = 465.

With complex aortic atheromatosis (CAA): aortic plaques

≥ 4 mm, with ulcers, thrombi or aortic debris: ps = 136.

Follow-up: 1596 days (mean: 759 days). A total of 520 ps (86.52%) were contacted; the following events were considered: transient ischemic attack or stroke, AMI, angina, revascularization and/or cause of mortality during that period. Multivariate analysis was used to identify independent predictors. A p value < 0.01 was considered statistically significant.


Cardiovascular mortality: 3.2% (13/407 ps) in group a and 18.6% (21/113 ps) in group b (p<0.01). Combined vascular events: 91/407 ps (22.4%) in group a and 45/113 ps (39.8%) in group b (p<0.01). Multivariate analysis showed that CAA was an independent predictor of cardiovascular mortality (OR 4.54, 95% CI 1.52-13.58, p<0.01) and of cerebrovascular and/or coronary events (OR 3.33, 95% CI 1.66-6.67, p<0.01).



In this population, CAA was an independent predictor of cardiovascular mortality and combined vascular events.


Petty GW, Khandheria BK, Meissner I, Whisnant JP, Rocca WA,

Sicks JD, et al. Population-based study of the relationship between

atherosclerotic aortic debris and cerebrovascular ischemic events.

Mayo Clin Proc 2006;81:609-14.

Casella G, Greco C, Perugini E, Pallotti MG, Pavesi PC, Di Pasquale

G. Atheromatosis of the thoracic aorta and risk of stroke. G Ital

Cardiol (Rome). 2006;7:309-16.

De Castro S, Rasura M, Di Angelantonio E, Beccia M, Passaseo I, Di

Lisi F, et al. Distribution of potential cardiac sources of embolism in

young and older stroke patients: implications for recurrent vascular

events. J Cardiovasc Med (Hagerstown) 2006;7:191-6.

Kronzon I, Tunick PA. Aortic atherosclerotic disease and stroke.

Circulation 2006;114:63-75.

Meissner I, Khandheria BK, Sheps SG, Schwartz GL, Wiebers DO,

Whisnant JP, et al. Atherosclerosis of the aorta: risk factor, risk marker,

or innocent bystander? A prospective population-based transesophageal

echocardiography study. J Am Coll Cardiol. 2004;44:1018-24.

Russo C, Jin Z, Rundek T, Homma S, Sacco RL, Di Tullio

MR. Atherosclerotic disease of the proximal aorta and the risk

of vascular events in a population-based cohort: the Aortic

Plaques and Risk of Ischemic Stroke (APRIS) study. Stroke


Touboul PJ, Hennerici MG, Meairs S, Adams H, Amarenco P, Bornstein

N, et al. Mannheim carotid intima-media thickness consensus

(2004-2006). An update on behalf of the Advisory Board of the 3rd

and 4th Watching the Risk Symposium, 13th and 15th European Stroke

Conferences, Mannheim, Germany, 2004, and Brussels, Belgium,

Cerebrovasc Dis 2007;23:75-80.

Amarenco P, Cohen A, Tzourio C, Bertrand B, Hommel M, Besson

G, et al. Atherosclerotic disease of the aortic arch and the risk of

ischemic stroke. N Engl J Med 1994;331:1474-9.

Witteman JC, Kannel WB, Wolf PA, Grobbee DE, Hofman A,

D’Agostino RB, et al. Aortic calcified plaques and cardiovascular

disease (the Framingham Study). Am J Cardiol 1990;66:1060-4.

Tunick PA, Kronzon I. The improved yield of transesophageal

echocardiography over transthoracic echocardiography in patients with neurological events is largely due to the detection of aortic

protruding atheromas. Echocardiography 1992;9:491-5.

Kutz SM, Lee VS, Tunick PA, Krinsky GA, Kronzon I. Atheromas

of the thoracic aorta: A comparison of transesophageal echocardiography

and breath-hold gadolinium-enhanced 3-dimensional magnetic

resonance angiography. J Am Soc Echocardiogr 1999;12:853-8.

Reynolds HR, Tunick PA, Kronzon I. Role of transesophageal

echocardiography in the evaluation of patients with stroke. Curr

Opin Cardiol 2003;18:340-5.

Fazio GP, Redberg RF, Winslow T, Schiller NB. Transesophageal

echocardiographically detected atherosclerotic aortic plaque is a

marker for coronary artery disease. J Am Coll Cardiol 1993;21:144-50.

Tunick PA, Rosenzweig BP, Katz ES, Freedberg RS, Perez JL,

Kronzon I. High risk for vascular events in patients with protruding

aortic atheromas: a prospective study. J Am Coll Cardiol.


Deschle H, Salazar A, Pissinis R, Carrascosa P, Carrascosa

J. Ateromatosis de la aorta torácica: su valor como predictor de

eventos coronarios y cerebrales. Rev Argent Cardiol 2004;72:133

(Abstract 83).

Mitusch R, Doherty C, Wucherpfennig H, Memmesheimer C, Tepe

C, Stierle U, et al. Vascular events during follow-up in patients with

aortic arch atherosclerosis. Stroke 1997;28:36-9.

Tunick PA, Kronzon I. Atheromas of the thoracic aorta: clinical

and therapeutic update. J Am Coll Cardiol 2000;35:545-54.

Agmon Y, Khandheria BK, Meissner I, Schwartz GL, Petterson

TM, O’Fallon WM, et al. Relation of coronary artery disease and

cerebrovascular disease with atherosclerosis of the thoracic aorta

in the general population. Am J Cardiol 2002; 89:262-7.

Macleod MR, Amarenco P, Davis SM, Donnan GA. Atheroma of

the aortic arch: an important and poorly recognised factor in the

aetiology of stroke. Lancet Neurol 2004;3:408-14.

Perez E, Hecht G, Harwicz P, Zimmerman E. Ateromatosis

aortica: un indicador de riesgo cardiovascular. Rev Argent Cardiol


Perez D, Casas CH, Harwicz P, Zimmermam E, Hecht G. Cuantificación

de la ateromatosis aórtica por eco transesofágico y su

implicancia pronóstica. Rev Argent Cardiol 2004;72:30-5.

Tunick PA, Kronzon I. Atherosclerosis of the aorta: a risk

factor, risk marker, or an innocent bystander? J Am Coll Cardiol


Fujimoto S, Yasaka M, Otsubo R, Oe H, Nagatsuka K, Minematsu

K. Aortic arch atherosclerotic lesions and the recurrence of ischemic

stroke. Stroke 2004;35:1426-9.

Pujadas R, Arboix A, Anguera N, Oliveres M, Massons J, Comes

E. Role of complex aortic atheroma plaques in the recurrence of

unexplained cerebral infarction. Rev Esp Cardiol 2005;58:34-40.

Ward RP, Don CW, Furlong KT, Lang RM. Predictors of long-term

mortality in patients with ischemic stroke referred for transesophageal

echocardiography. Stroke 2006;37:204-8.

Bugnicourt JM, Chillon JM, Tribouilloy C, Canaple S, Lamy C,

Massy ZA, et al. Relation between intracranial artery calcifications

and aortic atherosclerosis in ischemic stroke patients. J Neurol


Harloff A, Simon J, Brendecke S, Assefa D, Helbing T, Frydrychowicz

A, et al. Complex plaques in the proximal descending aorta: an

underestimated embolic source of stroke. Stroke 2010;41:1145-50.

Gupta N, Lau C, Al-Dehneh A, Daoko J, Vazir A, Parikh R, et al.

Importance of performing transesophageal echocardiography in acute

stroke patients older than fifty. Echocardiography 2010;27:1086-92.

Harloff A, Strecker C, Dudler P, Nussbaumer A, Frydrychowicz

A, Olschewski M, et al. Retrograde embolism from the descending

aorta: visualization by multidirectional 3D velocity mapping in

cryptogenic stroke. Stroke 2009;40:1505-8.

Di Tullio MR, Russo C, Jin Z, Sacco RL, Mohr JP, Homma S;

Patent Foramen Ovale in Cryptogenic Stroke Study Investigators.

Aortic arch plaques and risk of recurrent stroke and death. Circulation


Kristman V, Manno M, Côté P. Loss to follow-up in cohort studies:

how much is too much? Eur J Epidemiol 2004;19:751-60.

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