Imaging Institute, Cleveland Clinic, Cleveland, Ohio 44106, USA.
JACC Cardiovasc Imaging. 2010 Oct;3(10):1020-9. doi: 10.1016/j.jcmg.2010.08.006.
We hypothesized that the extent of aortic atheroma of the entire thoracic aorta, determined by pre-operative multidetector-row computed tomographic angiography (MDCTA), is associated with long-term mortality following nonaortic cardiothoracic surgery.
In patients evaluated for cardiothoracic surgery, presence of severe aortic atheroma is associated with adverse short- and long-term post-operative outcome. However, the relationship between aortic plaque burden and mortality remains unknown.
We reviewed clinical and imaging data from all patients who underwent electrocardiographic-gated contrast-enhanced MDCTA prior to coronary bypass or valvular heart surgery at our institution between 2002 and 2008. MDCTA studies were analyzed for thickness and circumferential extent of aortic atheroma in 5 segments of the thoracic aorta. A semiquantitative total plaque-burden score (TPBS) was calculated by assigning a score of 1 to 3 to plaque thickness and to circumferential plaque extent. When combined, this resulted in a score of 0 to 6 for each of the 5 segments and, hence, an overall score from 0 to 30. The primary end point was all-cause mortality during long-term follow-up.
A total of 862 patients (71% men, 67.8 years) were included and followed over a mean period of 25 ± 16 months. The mean TPBS was 8.6 (SD: ±6.0). The TPBS was a statistically significant predictor of mortality (p < 0.0001) while controlling for baseline demographics, cardiovascular risk factors, and type of surgery including reoperative status. The estimated hazard ratio for TPBS was 1.08 (95% confidence interval: 1.045 to 1.12). Other independent predictors of mortality were glomerular filtration rate (p = 0.015), type of surgery (p = 0.007), and peripheral artery disease (p = 0.03).
Extent of thoracic aortic atheroma burden is independently associated with increased long-term mortality in patients following cardiothoracic surgery. Although our data do not provide definitive evidence, they suggest a relationship to the systemic atherosclerotic disease process and, therefore, have important implications for secondary prevention in post-operative rehabilitation programs.
我们假设，通过术前多排螺旋 CT 血管造影（MDCTA）确定的整个胸主动脉粥样硬化程度与非主动脉心胸外科手术后的长期死亡率相关。
在接受心胸外科手术评估的患者中，严重的主动脉粥样硬化与不良的短期和长期术后结果相关。然而，主动脉斑块负担与死亡率之间的关系尚不清楚。
我们回顾了 2002 年至 2008 年间在我们机构接受心电图门控对比增强 MDCTA 的所有接受冠状动脉旁路或心脏瓣膜手术的患者的临床和影像学数据。MDCTA 研究分析了胸主动脉 5 个节段的主动脉粥样硬化厚度和周向范围。通过将斑块厚度和周向斑块范围分别评为 1 至 3 分，计算出半定量总斑块负担评分（TPBS）。组合后，每个节段的得分从 0 至 6 分，因此总分为 0 至 30 分。主要终点是长期随访期间的全因死亡率。
共纳入 862 例患者（71%为男性，67.8 岁），平均随访 25±16 个月。平均 TPBS 为 8.6（标准差：±6.0）。TPBS 是死亡率的统计学显著预测因子（p<0.0001），同时控制了基线人口统计学、心血管危险因素和手术类型，包括再次手术状态。TPBS 的估计危险比为 1.08（95%置信区间：1.045 至 1.12）。死亡率的其他独立预测因子包括肾小球滤过率（p=0.015）、手术类型（p=0.007）和外周动脉疾病（p=0.03）。
胸主动脉粥样硬化负担程度与心胸外科手术后患者的长期死亡率增加独立相关。尽管我们的数据没有提供确凿的证据，但它们表明与系统性动脉粥样硬化疾病过程有关，因此对术后康复计划中的二级预防具有重要意义。
