Goland Sorel, Trento Alfredo, Czer Lawrence S C, Eshaghian Shervin, Tolstrup Kirsten, Naqvi Tasneem Z, De Robertis Michele A, Mirocha James, Iida Kiyoshi, Siegel Robert J
Division of Cardiology, Department of Cardiothoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Ann Thorac Surg. 2008 Jan;85(1):113-9. doi: 10.1016/j.athoracsur.2007.08.025.
The association between the severity of arteriosclerosis in the thoracic aorta in patients with isolated aortic stenosis (AS) and with concomitant coronary artery disease (CAD) has been not evaluated. Therefore, the aim of our study was to compare the thoracic aortic atheroma extent and severity in patients with severe AS alone and with concomitant CAD by intraoperative transesophageal echocardiography.
We retrospectively evaluated echocardiograms of 105 consecutive patients with severe degenerative AS who underwent aortic valve replacement. Sixty patients had concomitant CAD (AS/CAD) on coronary angiography and 45 had no CAD (AS alone). These patients were compared with 54 sex- and age-matched patients without AS or CAD. Aortic atheroma (localized intimal thickening of >3 mm) prevalence and morphology in three segments of aorta were assessed with echocardiography.
There were 62 men, mean age 75.3 +/- 9.4 years. No difference was observed in age, sex, and risk factors for arteriosclerosis other than hypercholesterolemia among AS/CAD, AS alone, and control groups (88%, 67%, 41%, respectively; p < 0.0001). The AS/CAD group had a significantly higher rate of aortic root calcification (68%, 36%, 26%, respectively; p < 0.0001) and aortic atheroma (ascending aorta [26%, 20%, 14%, respectively; p = 0.03]; aortic arch [78%, 36%, 30%, respectively; p < 0.0001]; descending aorta [72%, 42%, 29%, respectively; p < 0.0001]) than AS alone or control subjects. Patients with AS/CAD also had more complex atheromas in the aortic arch (48%, 20%, 7%, respectively; p < 0.0001). Significant differences in extension of aortic arteriosclerosis (presence of plaques in two or three segments) were observed among the groups (70%, 31%, 18%, respectively; p < 0.0001).
Patients with severe AS and coexisting CAD have more extensive arteriosclerotic changes in the thoracic aorta compared with those with AS alone and control subjects. Preoperative evaluation of the thoracic aorta and more aggressive lipid therapy should be considered in these patients.
孤立性主动脉瓣狭窄（AS）患者以及合并冠状动脉疾病（CAD）患者的胸主动脉动脉硬化严重程度之间的关联尚未得到评估。因此，我们研究的目的是通过术中经食管超声心动图比较单纯严重AS患者和合并CAD患者的胸主动脉粥样硬化范围及严重程度。
我们回顾性评估了105例连续接受主动脉瓣置换术的严重退行性AS患者的超声心动图。60例患者冠状动脉造影显示合并CAD（AS/CAD组），45例无CAD（单纯AS组）。将这些患者与54例年龄和性别匹配、无AS或CAD的患者进行比较。通过超声心动图评估主动脉三个节段的主动脉粥样硬化（局部内膜增厚>3mm）患病率及形态。
共62例男性，平均年龄75.3±9.4岁。AS/CAD组、单纯AS组和对照组在年龄、性别以及除高胆固醇血症外的动脉硬化危险因素方面未观察到差异（分别为88%、67%、41%；p<0.0001）。AS/CAD组主动脉根部钙化率（分别为68%、36%、26%；p<0.0001）和主动脉粥样硬化（升主动脉[分别为26%、20%、14%；p=0.03]；主动脉弓[分别为78%、36%、30%；p<0.0001]；降主动脉[分别为72%、42%、29%；p<0.0
