基于主动脉粥样硬化形态学特征和主动脉自发超声心动图对比的栓塞风险

Finkelhor R S, Youssefi M E, Lamont W E, Bahler R C

Case Western Reserve University at MetroHealth Medical Center, Cleveland, Ohio 44109, USA.

Am Heart J. 1999 Jun;137(6):1088-93. doi: 10.1016/s0002-8703(99)70367-4.

BACKGROUND

Different aortic atherosclerotic plaque morphologic features may have varying embolic potentials. Spontaneous echocardiographic contrast (SEC) in the aorta, as in the left atrium, has been associated with an increased risk of embolic events and often occurs with complex aortic atherosclerosis. Thus an evaluation of their isolated and combined association with embolic events was undertaken.

METHODS

We retrospectively studied all patients who underwent biplane or multiplane transesophageal echocardiography meeting the following inclusion and exclusion criteria: age >/=55 years and no other cardiac pathologic condition known to be associated with embolic events other than aortic atherosclerosis or aortic SEC. The 105 patients meeting the criteria were divided into those with aortic atherosclerosis and/or aortic SEC (the study group) and those without these aortic pathologic conditions (the comparison group). Complex aortic atherosclerosis was defined as mobile, ulcerated, or protuberant (> 4 mm). SEC was defined as a pulsatile, swirling echo pattern within the aortic lumen. Embolic events included strokes, transient ischemic attacks, or peripheral emboli.

RESULTS

The 61 study patients and 44 comparison patients did not significantly differ with respect to the reason for referral, age, or sex. Embolic events occurred in 35 patients. Those with ulcerated or mobile plaques had a greater prevalence of embolic events (odds ratio 4.50; 95% confidence interval, 1.30-15.5; P <.05). The highest embolic event rate was seen in patients with any complex atherosclerosis and concomitant SEC (odds ratio 9.00; 95% confidence interval, 2.06-39.3; P <.01). Patients with SEC alone or protuberant plaques alone did not have a higher event rate (odds ratio 1.71 and 0.60; 95% confidence interval, 0.57-5.17 and 0.15-2. 47, respectively).

CONCLUSIONS

Embolic events were associated with the presence of ulcerated or mobile aortic plaques. In addition, the combination of aortic SEC and any complex atherosclerosis had the highest embolic association.

背景

不同的主动脉粥样硬化斑块形态特征可能具有不同的栓塞潜能。与左心房一样，主动脉内的自发超声造影（SEC）与栓塞事件风险增加相关，且常与复杂的主动脉粥样硬化同时出现。因此，我们对它们与栓塞事件的单独及联合关联进行了评估。

方法

我们回顾性研究了所有接受双平面或多平面经食管超声心动图检查且符合以下纳入和排除标准的患者：年龄≥55岁，且除主动脉粥样硬化或主动脉SEC外，无其他已知与栓塞事件相关的心脏病理状况。符合标准的105例患者被分为患有主动脉粥样硬化和/或主动脉SEC的患者（研究组）和无这些主动脉病理状况的患者（对照组）。复杂的主动脉粥样硬化定义为可移动、溃疡或突出（>4mm）。SEC定义为主动脉腔内的搏动性、漩涡状回声模式。栓塞事件包括中风、短暂性脑缺血发作或外周栓塞。

结果

61例研究组患者和44例对照组患者在转诊原因、年龄或性别方面无显著差异。35例患者发生了栓塞事件。有溃疡或可移动斑块的患者发生栓塞事件的患病率更高（比值比4.50；95%置信区间，1.30 - 15.5；P<.05）。在患有任何复杂动脉粥样硬化并伴有SEC的患者中，栓塞事件发生率最高（比值比9.00；95%置信区间，2.06 - 39.3；P<.01）。单独患有SEC或单独有突出斑块的患者事件发生率没有更高（比值比分别为1.71和0.60；95%置信区间分别为0.57 - 5.17和0.15 - 2.47）。