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J Am Coll Cardiol, 1999; 33:1308-1316
© 1999 by the American College of Cardiology Foundation
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CLINICAL STUDIES

Atherosclerosis of the ascending aorta is an independent predictor of long-term neurologic events and mortality

Víctor G. Dávila-Román, MD, FACCa, Suzan F. Murphy, RN, BSNc,1, Nancy J. Nickerson, RN, BSNc, Nicholas T. Kouchoukos, MD, FACCc, Kenneth B. Schechtman, PhDb and Benico Barzilai, MD, FACCa

a Cardiovascular Division, Department of Internal Medicine, Washington University School of Medicine, and Barnes-Jewish Hospital, BJC Health System, St. Louis, Missouri, USA
b Department of Biostatistics, Washington University School of Medicine, and Barnes-Jewish Hospital, BJC Health System, St. Louis, Missouri, USA
c Cardiothoracic Surgery Division, Department of Surgery, Washington University School of Medicine, and Barnes-Jewish Hospital, BJC Health System, St. Louis, Missouri, USA

Manuscript received August 14, 1998; revised manuscript received December 1, 1998, accepted January 11, 1999.

Reprint requests and correspondence: Dr. Víctor G. Dávila-Román, Cardiovascular Division, Box 8086, Washington University, 660 S. Euclid Ave., St. Louis, Missouri 63110
vdavila{at}imgate.wustl.edu

Presented in part at the 69th Scientific Sessions of the American Heart Association, New Orleans, November 1996.

OBJECTIVES

This study was undertaken to determine whether atherosclerosis of the ascending aorta is a predictor of long-term neurologic events and mortality.

BACKGROUND

Atherosclerosis of the thoracic aorta has been recently considered a significant predictor of neurologic events and peripheral embolism, but not of long-term mortality.

METHODS

Long-term follow-up (a total of 5,859 person-years) was conducted of 1,957 consecutive patients ≥50 years old who underwent cardiac surgery. Atherosclerosis of the ascending aorta was assessed intraoperatively (epiaortic ultrasound) and patients were divided into four groups according to severity (normal, mild, moderate or severe). Carotid artery disease was evaluated (carotid ultrasound) in 1,467 (75%) patients. Cox proportional-hazards regression analysis was performed to assess the independent effect of predictors on neurologic events and mortality.

RESULTS

A total of 491 events occurred in 472 patients (neurologic events 92, all-cause mortality 399). Independent predictors of long-term neurologic events were: hypertension (p = 0.009), ascending aorta atherosclerosis (p = 0.011) and diabetes mellitus (p = 0.015). The independent predictors of mortality were advanced age (p < 0.0001), left ventricular dysfunction (p < 0.0001), ascending aorta atherosclerosis (p < 0.0001), hypertension (p = 0.0001) and diabetes mellitus (p = 0.0002). There was >1.5-fold increase in the incidence of both neurologic events and mortality as the severity of atherosclerosis increased from normal-mild to moderate, and a greater than threefold increase in the incidence of both as the severity of atherosclerosis increased from normal-mild to severe.

CONCLUSIONS

Atherosclerosis of the ascending aorta is an independent predictor of long-term neurologic events and mortality. These results provide additional evidence that in addition to being a direct cause of cerebral atheroembolism, an atherosclerotic ascending aorta may be a marker of generalized atherosclerosis and thus of increased morbidity and mortality.

Abbreviations and Acronyms
  CABG = coronary artery bypass graft
  CAD = coronary artery disease
  FAPS = French Aortic Plaques in Stroke study
  LV = left ventricle
  LVEF = left ventricular ejection fraction
  TEE = transesophageal echocardiography
  TIA = transient ischemic attack




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