(Circulation. 1997;96:3838-3841.)
© 1997 American Heart Association, Inc.
Articles |
Aortic Plaque Morphology and Vascular Events
A Follow-up Study in Patients With Ischemic Stroke
From the Service de Cardiologie (A.C., C.C.) and de Neurologie (C.T., P.A., M.G.B.), Saint-Antoine University and Medical School, Paris, INSERM U 360 Recherches en Epidémiologie (C.T.), Hôpital Pitié-Salpétrière, the Clinique Cardiologique (B.B.), CHU de Grenoble, Grenoble, France.
Correspondence to Ariel Cohen, MD, PhD, Service de Cardiologie, Saint-Antoine University and Medical School, Université Pierre et Marie Curie, 184, rue du faubourg St-Antoine, 75571 Paris Cedex 12, France. E-mail ariel.cohen{at}sat.ap-hp-paris.fr
Background Atherosclerotic disease of the aortic arch has
been found to be associated with the risk of ischemic stroke.
We have shown that atherosclerotic plaques 
4 mm in thickness in
the ascending aorta and proximal arch detected by
transesophageal echocardiography
are a risk factor for ischemic stroke. The purpose of this
study was to evaluate the impact, if any, of plaque morphology
(ulceration, hypoechoic plaques or calcification) on the risk of
subsequent vascular events.
Methods and Results We followed for a period of 2 to 4 years, a
cohort of 334 patients 60 years or older who were consecutively
admitted with brain infarction and who had
transesophageal echocardiography.
The risk of vascular events in patients with plaques in the aortic arch
according to the presence of surface ulceration, calcifications, and
sessile or mobile thrombus was estimated during a total of 788
person-years of follow-up. Hypoechoic plaques, calcifications, and
ulceration were more frequently found in patients with plaques 4
mm as compared with those with plaques <4 mm. The presence of
ulceration did not increase the relative risk of vascular events in
patients with plaque 4 mm (the relative risk was 4.3
[P<.001] in those with ulceration and 5.7
[P<.001]) in those without ulceration. The lack of
calcification did increase the risk of vascular events in patients with
plaque 4 mm. The highest relative risk of events was found among
the patients with noncalcified plaques (relative risk, 10.3; 95%
confidence interval, 4.2 to 25.2; P<.001). The risk of
events was systematically higher in patients without calcifications
than in patients with calcifications regardless of what other
morphological features were considered.
Conclusions In patients with brain infarction, the risk
associated with aortic plaque thickness (4 mm) is markedly
increased by the absence of plaque calcifications. These findings are
important for the design of therapeutic trials in such patients.
Key Words: aortic arch • atherosclerotic disease • plaque • calcifications • stroke • echocardiography
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