Impact of aortic stiffness on progression of aortic atheroma in patients with stroke

초록

Background: Aortic atheroma is an independent risk factor for stroke and undergoes temporal progression. However, the relationship between aorta atheroma (AA) and vascular properties is not fully elucidated. This study aimed to examine temporal changes in aortic plaques with transesophageal echocardiography (TEE) and to clarify the characteristics of the aorta affecting atheroma change. Methods: One hundred sixty-eight stroke patients who underwent TEE from July 2010 to August 2019 were enrolled. The thickness and morphology of AA and the presence of thrombus were examined. Temporal changes in AA were investigated by comparing baseline and follow-up TEE. Clinical factors, laboratory data, and medications including statin were evaluated. Aortic stiffness was evaluated using pulse wave analysis (PWA) and aorta strain analysis. Results: Except for 37 patients who did not undergo follow-up TEE, 131 patients were finally enrolled. During the median follow-up of 23.7 (21.1-26.7) months, 14 (10.7%) were regressed, 13 (9.9%) were progressed, and 104 (79.4%) remained unchanged. While the female gender shows more incidence of AA progression (69.2%, p=0.02), the initial and follow-up levels of low-density lipoprotein (LDL) did not show any significant difference among the three groups (p=0.60, p=0.68, respectively). In statin use, there was no significant difference among the 3 groups (p=0.16). According to the parameters of aorta stiffness, regression group had a lower augmentation index adjusted to a heart rate of 75 beats per minute (AIx@HR75, 20.3±15.2% vs. 31.0±2.2% vs. 30.7±6.6%, p =0.05). For global circumferential aorta strain (GCAS), regression group showed higher value than other groups (±% vs. ±% vs. ±%, p =0.0) Conclusion: GCAS evaluated by TEE was able to predict the prognosis of AA. Increased aortic stiffness is considered a risk factor for AA progression whereas LDL and statin levels were not associated.