High risk for vascular events in patients with protruding aortic atheromas: a prospective study

Charles and Rose Wholstetter Noninvasive Cardiology Laboratory, Department of Medicine, New York University Medical Center, New York.

OBJECTIVES. The purpose of this study was to prospectively evaluate the risk of vascular events in patients with protruding aortic atheromas. BACKGROUND. Protruding atheromas of the thoracic aorta have been shown to be associated with embolic disease in previous retrospective studies. METHODS. 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. RESULTS. 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). CONCLUSIONS. Protruding atheromas seen on transesophageal echocardiography predict future vascular events.

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