Tenenbaum A, Fisman E Z, Schneiderman J, Stroh C I, Shemesh J, Schwammenthal E, Vered Z, Motro M
Cardiac Rehabilitation Institute, Department of Vascular Surgery, Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Cardiology. 1998 May;89(4):246-51. doi: 10.1159/000006795.
Protruding aortic plaques--especially those with mobile properties--on transesophageal echocardiography (TEE) are a potential source of stroke and systemic embolism in the elderly. Whether the various morphologies of atheromas with mobile components represent potential differences in the risk for embolic events has not been thoroughly elucidated. The goal of the present study was to determine the association between embolic events and the various types of mobile lesions in the thoracic aorta. Our population consisted of 569 consecutive patients (age 18-83 years) referred for TEE over 27 months; 108 (19%) of them were referred to evaluate recent embolism (cerebral in 97 and peripheral or both in 11; group I) and the remaining 461 were admitted for reasons unrelated to embolism (group II). In group I, 35 patients (32%) exhibited protruding plaques; those were fixed in 10 (9%) and with a mobile component in 25 (23%). In group II, plaques were found in only 13 patients (3%); fixed in 9 (2%) and mobile in 4 (1 %). Twenty-four patients with mobile lesions in group I were > 50 years old, and 21 of them (88%) were > 60 years old. While the presence of fixed plaques was associated with a moderate increase in the risk for systemic embolism (adjusted odds ratio 4.1; 95% confidence interval 1.3-56.4), mobile lesions were linked to a striking augmentation of this risk (odds ratio 30.1; 95% confidence interval 7.8-132.6). The majority of mobile lesions (76%) in group I represented disrupted atheromas with characteristic ulcerations or echolucency within the plaque suggestive of intraatheroma hemorrhage, whereas these TEE features were not observed in 89% of the mobile lesions in group II (p = 0.0003). We conclude that among the various types of mobile aortic lesions, the disrupted protruding plaques are a major risk factor for stroke and embolic events in the elderly.
经食管超声心动图（TEE）检查发现的突出主动脉斑块——尤其是具有移动特性的斑块——是老年人发生中风和全身栓塞的潜在来源。含有可移动成分的动脉粥样硬化的各种形态是否代表栓塞事件风险的潜在差异尚未得到充分阐明。本研究的目的是确定栓塞事件与胸主动脉中各种类型的可移动病变之间的关联。我们的研究对象包括在27个月内连续接受TEE检查的569例患者（年龄18 - 83岁）；其中108例（19%）因近期栓塞前来评估（97例为脑栓塞，11例为外周栓塞或两者皆有；第一组），其余461例因与栓塞无关的原因入院（第二组）。在第一组中，35例患者（32%）有突出斑块；其中10例（9%）为固定斑块，25例（23%）有可移动成分。在第二组中，仅13例患者（3%）发现有斑块；9例（2%）为固定斑块，4例（1%）为可移动斑块。第一组中有24例有可移动病变的患者年龄大于50岁，其中21例（88%）年龄大于60岁。虽然固定斑块的存在与全身栓塞风险适度增加相关（调整后的优势比为4.1；95%置信区间为1.3 - 56.4），但可移动病变与该风险的显著增加相关（优势比为30.1；95%置信区间为7.8 - 132.6）。第一组中大多数可移动病变（76%）表现为破裂的动脉粥样硬化，斑块内有特征性溃疡或无回声区提示动脉粥样硬化内出血，而第二组中89%的可移动病变未观察到这些TEE特征（p = 0.0003）。我们得出结论，在各种类型的可移动主动脉病变中，破裂的突出斑块是老年人发生中风和栓塞事件的主要危险因素。
