CORRESPONDENCE: LETTER TO THE EDITOR
Atherosclerosis of the Aorta: A Risk Factor, Risk Marker, or an Innocent Bystander?
Paul A. Tunick, MD* and
Itzhak Kronzon, MD
* NYU School of Medicine, 560 First Avenue, New York, NY 10016 (Email: paul.tunick{at}med.nyu.edu).
In a recent issue of the Journal, Meissner et al. (1) should be congratulated for carrying out a community-based transesophageal echocardiography (TEE) study of thoracic aortic plaque. However, because they included patients with descending aortic plaque (which is more prevalent than arch plaque), their negative conclusions regarding stroke are flawed. It is simply not plausible to consider plaque limited to the descending aorta as a cause of cerebral embolization.
Earlier studies of aortic arch plaque have found a 12% (2), 12% (3), and 13.7% (4) risk of cerebral embolization. This is 50% higher than the 8% risk of stroke in the "high risk" Stroke Prevention in Atrial Fibrillation (SPAF)-III study patients (5). In fact, if these "high risk" Stroke Prevention in Atrial Fibrillation (SPAF) study patients had no significant plaque in the aorta on TEE, their risk fell to 1.2%.
Although the investigators recognize this problem in their limitations section, we would like to re-emphasize that aortic arch plaque is associated with a high risk of stroke.
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1. Meissner I, Khandheria BK, Sheps S, et al. Atherosclerosis of the aortarisk factor, risk marker, or innocent bystander?. J Am Coll Cardiol 2004;44:1018-1024.[Abstract/Free Full Text]
2. Tunick PA, Katz ES, Freedberg RS, Rosenzweig BP, Perez JL, Kronzon I. High risk for vascular events in patients with protruding aortic atheromasa prospective study. J Am Coll Cardiol 1994;23:1085-1090.[Abstract]
3. Amarenco P, Cohen A, Tzourio C, et al. Atherosclerotic disease of the aortic arch and the risk of ischemic stroke N Engl J Med 1994;331:1474-1479.[CrossRef][Web of Science][Medline]
4. Mitusch R, Doherty C, Wucherpfennig H, et al. Vascular events during follow-up in patients with aortic arch atherosclerosis Stroke 1997;28:35-39.
5. The Stroke Prevention in Atrial Fibrillation Investigators Committee on Echocardiography Transesophageal echocardiography correlates of thromboembolism in high-risk patients with nonvalvular atrial fibrillation Ann Intern Med 1998;128:639-647.[Abstract/Free Full Text]
Related Article
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Reply
- Irene Meissner and Bijoy K. Khandheria
J. Am. Coll. Cardiol. 2005 45: 1907.
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