Dávila-Román V G, Murphy S F, Nickerson N J, Kouchoukos N T, Schechtman K B, Barzilai B
Department of Internal Medicine, Washington University School of Medicine, and Barnes-Jewish Hospital, BJC Health System, St. Louis, Missouri, USA.
J Am Coll Cardiol. 1999 Apr;33(5):1308-16. doi: 10.1016/s0735-1097(99)00034-0.
This study was undertaken to determine whether atherosclerosis of the ascending aorta is a predictor of long-term neurologic events and mortality.
Atherosclerosis of the thoracic aorta has been recently considered a significant predictor of neurologic events and peripheral embolism, but not of long-term mortality.
Long-term follow-up (a total of 5,859 person-years) was conducted of 1,957 consecutive patients > or =50 years old who underwent cardiac surgery. Atherosclerosis of the ascending aorta was assessed intraoperatively (epiaortic ultrasound) and patients were divided into four groups according to severity (normal, mild, moderate or severe). Carotid artery disease was evaluated (carotid ultrasound) in 1,467 (75%) patients. Cox proportional-hazards regression analysis was performed to assess the independent effect of predictors on neurologic events and mortality.
A total of 491 events occurred in 472 patients (neurologic events 92, all-cause mortality 399). Independent predictors of long-term neurologic events were: hypertension (p = 0.009), ascending aorta atherosclerosis (p = 0.011) and diabetes mellitus (p = 0.015). The independent predictors of mortality were advanced age (p < 0.0001), left ventricular dysfunction (p < 0.0001), ascending aorta atherosclerosis (p < 0.0001), hypertension (p = 0.0001) and diabetes mellitus (p = 0.0002). There was >1.5-fold increase in the incidence of both neurologic events and mortality as the severity of atherosclerosis increased from normal-mild to moderate, and a greater than threefold increase in the incidence of both as the severity of atherosclerosis increased from normal-mild to severe.
Atherosclerosis of the ascending aorta is an independent predictor of long-term neurologic events and mortality. These results provide additional evidence that in addition to being a direct cause of cerebral atheroembolism, an atherosclerotic ascending aorta may be a marker of generalized atherosclerosis and thus of increased morbidity and mortality.
本研究旨在确定升主动脉粥样硬化是否为长期神经事件和死亡率的预测指标。
胸主动脉粥样硬化最近被认为是神经事件和外周栓塞的重要预测指标，但不是长期死亡率的预测指标。
对1957例年龄≥50岁的连续接受心脏手术的患者进行长期随访（总计5859人年）。术中通过主动脉外膜超声评估升主动脉粥样硬化情况，并根据严重程度将患者分为四组（正常、轻度、中度或重度）。对1467例（75%）患者进行了颈动脉疾病评估（颈动脉超声）。采用Cox比例风险回归分析评估预测指标对神经事件和死亡率的独立影响。
472例患者共发生491起事件（神经事件92起，全因死亡率399起）。长期神经事件的独立预测指标为：高血压（p = 0.009）、升主动脉粥样硬化（p = 0.011）和糖尿病（p = 0.015）。死亡率的独立预测指标为高龄（p < 0.0001）、左心室功能障碍（p < 0.0001）、升主动脉粥样硬化（p < 0.0001）、高血压（p = 0.0001）和糖尿病（p = 0.0002）。随着粥样硬化严重程度从正常-轻度增加到中度，神经事件和死亡率的发生率增加超过1.5倍；随着粥样硬化严重程度从正常-轻度增加到重度，两者的发生率增加超过三倍。
升主动脉粥样硬化是长期神经事件和死亡率的独立预测指标。这些结果提供了额外的证据，表明除了是脑动脉粥样硬化栓塞的直接原因外，粥样硬化的升主动脉可能是全身性动脉粥样硬化的一个标志，从而也是发病率和死亡率增加的标志。
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