Tunick P A, Rosenzweig B P, Katz E S, Freedberg R S, Perez J L, Kronzon I
Charles and Rose Wholstetter Noninvasive Cardiology Laboratory, Department of Medicine, New York University Medical Center, New York.
J Am Coll Cardiol. 1994 Apr;23(5):1085-90. doi: 10.1016/0735-1097(94)90595-9.
The purpose of this study was to prospectively evaluate the risk of vascular events in patients with protruding aortic atheromas.
Protruding atheromas of the thoracic aorta have been shown to be associated with embolic disease in previous retrospective studies.
During a 1-year period, 521 patients had transesophageal echocardiography. Of these, 42 patients had protruding atheromas and no other source of emboli. They were followed up for up to 2 years (mean follow-up 14 months) and compared with a control group without atheromas, matched for age, gender and hypertension.
Of 42 patients with atheromas, 14 (33%) had 19 vascular events during follow-up (5 brain, 2 eye, 4 kidney, 1 bowel, 7 lower extremity). Of 42 control patients, 3 (7%) had vascular events (2 brain, 1 eye). Univariate analysis identified only protruding atheromas as significantly correlating with events (p = 0.003). There was no positive correlation of events with age, gender, hypertension, smoking, family history, atrial fibrillation, valve replacement, antithrombotic drug use, diabetes or coronary disease. Multivariate analysis showed that only protruding atheromas independently predicted events (p = 0.005, odds ratio 4.3, 95% confidence interval 1.2 to 15.0). Nine patients died in the atheroma group versus six in the control group, but this was not statistically significant (p = 0.39).
Protruding atheromas seen on transesophageal echocardiography predict future vascular events.
本研究旨在前瞻性评估主动脉粥样斑块突出患者发生血管事件的风险。
既往回顾性研究表明，胸主动脉粥样斑块突出与栓塞性疾病相关。
在1年时间里，对521例患者进行了经食管超声心动图检查。其中，42例患者有粥样斑块突出且无其他栓子来源。对他们进行了长达2年的随访（平均随访14个月），并与年龄、性别和高血压相匹配的无粥样斑块的对照组进行比较。
42例有粥样斑块的患者中，14例（33%）在随访期间发生了19次血管事件（5次脑部、2次眼部、4次肾脏、1次肠道、7次下肢）。42例对照患者中，3例（7%）发生了血管事件（2次脑部、1次眼部）。单因素分析仅发现粥样斑块突出与事件显著相关（p = 0.003）。事件与年龄、性别、高血压、吸烟、家族史、心房颤动、瓣膜置换、抗血栓药物使用、糖尿病或冠心病无正相关。多因素分析显示，只有粥样斑块突出可独立预测事件（p = 0.005，比值比4.3，95%置信区间1.2至15.0）。粥样斑块组有9例患者死亡，对照组有6例，但差异无统计学意义（p = 0.39）。
经食管超声心动图显示的粥样斑块突出可预测未来血管事件。
