Resumen de Atheromatosis of the Thoracic Aorta as Predictor of Cardiovascular Mortality and Cerebrovascular and Coronary Events

Héctor Deschle, Pablo Fernando Oberti, Jorge Lowenstein, Carlos Rodriguez Correa, Gastón Lanternier, Salvador Spina, Mariano L. Falconi, Eduardo Guevara, Silvia Makhoul, María Elena Adaniya

• español

  Objetivo Evaluar la gravedad de la ateromatosis de la aorta torácica y su relación con la mortalidad y los eventos vasculares cerebrales y coronarios.Material y métodosEntre 2005 y 2007 ingresaron prospectivamente 601 pacientes (p) enviados para ecocardiograma transesofágico (ETE).Edad: 64,53±13,61 años.Sexo masculino: 337 p.Se registró:Motivo del estudio: foco embolígeno (37,7%), endocarditis (22,1%), precardioversión (11,5%), valvulopatía mitral (9,8%), otros (18,95%).Factores de riesgo: diabetes, tabaquismo, hipertensión arterial, dislipemia.Presencia de fibrilación auricular.Los p fueron agrupados en:a)      Con  placas aórticas <4 mm y no complicadas: p = 465.b)     Con placas ³ 4 mm y/o ulceradas, con trombos o debris (ateromatosis aórtica compleja [AAC]): p = 136.Seguimiento: 1596 días (media: 759 días). Se contactaron 520 p (86,52%), considerándose los siguientes eventos: accidente cerebrovascular transitorio o permanente, IAM, angina, revascularización y/o causa de muerte en dicho período. Se utilizó el análisis multivariado para hallar predictores independientes. Se consideró significativa un p < de 0,01.Resultados:Mortalidad cardiovascular: 3,2% (13/407 p) en el grupo a y 18,6% (21/113 p) en el grupo b (p<0,01).Eventos vasculares combinados: 91/407 p (22,4%) en el grupo a y 45/113 p (39,8%) en el grupo b (p<0,01).En el análisis multivariado, la AAC fue predictora independiente de mortalidad cardiovascular (OR 4,54, 95% IC 1,52-13,58  p<0,01) y de eventos vasculares cerebrales y/o coronarios (OR 3,33, 95% IC 1,66-6,67 p<0,01).ConclusionEn esta población, la AAC fue predictora independiente de mortalidad cardiovascular y de eventos vasculares combinados.

• English

  Objective To evaluate the severity of atheromatosis of the thoracic aorta and its relation with mortality and cerebrovascular and coronary events.Material and MethodsBetween 2005 and 2007, 601 patients (ps) were referred for evaluation with transesophageal echocardiography (TEE).Age: 64.53±13.61 yearsMale gender: 337ps.The following variables were included:Reason for ordering the study: embolic source (37.7%), endocarditis (22.1%), previous to cardioversion (11.5%), mitral valve disease (9.8%), other reasons (18.95%). Risk factors: diabetes, smoking habits, hypertension, dyslipidemia. Presence of atrial fibrillation. The patients were divided into two groups:With uncomplicated aortic plaques < 4 mm: ps = 465.With complex aortic atheromatosis (CAA): aortic plaques≥ 4 mm, with ulcers, thrombi or aortic debris: ps = 136.Follow-up: 1596 days (mean: 759 days). A total of 520 ps (86.52%) were contacted; the following events were considered: transient ischemic attack or stroke, AMI, angina, revascularization and/or cause of mortality during that period. Multivariate analysis was used to identify independent predictors. A p value < 0.01 was considered statistically significant.ResultsCardiovascular mortality: 3.2% (13/407 ps) in group a and 18.6% (21/113 ps) in group b (p<0.01). Combined vascular events: 91/407 ps (22.4%) in group a and 45/113 ps (39.8%) in group b (p<0.01). Multivariate analysis showed that CAA was an independent predictor of cardiovascular mortality (OR 4.54, 95% CI 1.52-13.58, p<0.01) and of cerebrovascular and/or coronary events (OR 3.33, 95% CI 1.66-6.67, p<0.01). ConclusionsIn this population, CAA was an independent predictor of cardiovascular mortality and combined vascular events.