Korean Circ J.  2007 Aug;37(8):365-372. 10.4070/kcj.2007.37.8.365.

Prognostic Significance of Descending Thoracic Aorta Intima-Media Thickness in Patients with Coronary Atherosclerosis

• Yoon HJ
• Hyun DW
• Kwon TG
• Kim KH
• Bae JH

• KMID: 2029064
• DOI: http://doi.org/10.4070/kcj.2007.37.8.365

Abstract

BACKGROUND AND OBJECTIVES: While the clinical significance of descending thoracic aorta intima-media thickness (DTA-IMT) remains unclear, common carotid IMT (CIMT) is known to be associated with major adverse cardiovascular events (MACE) in patients with atherosclerotic disease.
SUBJECTS AND METHODS
A total of 104 patients (mean age, 59 yrs; 69 male) with angiographically proven coronary atherosclerosis underwent transesophageal echocardiography (TEE) for DTA-IMT measurement and carotid scanning for CIMT measurement. The patients were divided into two groups based on the median IMT value, and they were followed up for cardiovascular events and all-cause mortality for a period of 50+/-21 months.
RESULTS
Patients having a higher DTA-IMT value (n=44, >2.1 mm) had a higher chance of stroke (6.7% vs. 2.8%, p=0.04), peripheral vascular disease (6.7% vs. 1.9%, p=0.02), and death (2.9% vs. 0%, p=0.04) than those who had lower DTA-IMT values (n=60, < or =2.1 mm). The patients who had higher CIMT values (n=49, >0.089 mm) had a higher chance of peripheral vascular disease (16% vs 2%, p=0.009) than those having lower IMT values (n=55, < or =0.089 mm). However, there was no significant difference between the groups in terms of recurrent chest pain, heart failure, syncope, myocardial infarction or chronic kidney disease during the follow-up period. Multivariate Cox regression analysis revealed that increased DTA-IMT was associated with stroke (OR, 4.29; 95% CI, 1.076-17.181; p=0.039) and peripheral vascular disease (OR, 9.37; 95% CI, 1.571-55.499; p=0.014), whereas increased CIMT was associated with peripheral vascular disease (OR, 14.365; 95% CI, 1.050-196.540; p=0.046).
CONCLUSION
This study suggests that descending thoracic aorta IMT is more closely associated with prognosis in patients with coronary atherosclerosis than CIMT.

Keyword

Aorta; Carotid arteries; Atherosclerosis

MeSH Terms

Aorta
Aorta, Thoracic*
Atherosclerosis
Carotid Arteries
Chest Pain
Coronary Artery Disease*
Echocardiography, Transesophageal
Follow-Up Studies
Heart Failure
Humans
Mortality
Myocardial Infarction
Peripheral Vascular Diseases
Prognosis
Renal Insufficiency, Chronic
Stroke
Syncope

Figure

• 

  Fig. 1 Descending thoracic aorta IMT was measured in the most thickened wall in the field visualized in end-diastole, except in the area of plaques. The descending aorta was focused upon in the far wall and again a 1 cm long segment was measured at 2mm intervals. The average value of each of the six IMT measurements of the descending thoracic aorta was taken as the evaluable IMT of the aorta. IMT: intima-media thickness.

• 

  Fig. 2 Incidence of major adverse cardiovascular event according to the descending thoracic IMT (A) and carotid IMT (B). Base on the descending thoracic aorta IMT mean values, subjects were grouped into high (n=44, ≤0.21 mm) and low IMT (n=60, >0.21 mm). *: statistically significant difference at the 0.05 levels. IMT: intima-media thickness, CHF: congestive heart failure, MI: myocardial infaction, CKD: chronic kidney disease, PVD: peripheral vascular disease.

• 

  Fig. 3 Kaplan-Meier curves for event free survival associated with stroke (A), peripheral vascular disease (B), and death (C). Base on the descending thoracic aorta IMT mean values, subjects were grouped into high (n=44, ≤0.21 mm, marked as blanked circle) and low IMT (n=60, >0.21 mm, marked as blanked square). IMT: intima-media thickness.

• 

  Fig. 4 Incidence of major adverse cardiovascular event according to the descending thoracic aorta plaque (A) and carotid plaque (B). Base on the presence of descending thoracic aorta plaque, subjects were grouped into present plaque (n=43) and absent plaque (n=61). *: statistically significant difference at the 0.05 levels. CHF: congestive heart failure, MI: myocardial infarction, CKD: chronic kidney disease, PVD: peripheral vascular disease.

• 

  Fig. 5 Kaplan-Meier curves for event free survival associated with stroke (A), peripheral vascular disease (B), and death (C). Base on the presence of descending thoracic aorta plaque, subjects were grouped into present plaque (n=43, marked as blanked circle) and absent plaque (n=61, marked as blanked triangle).

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