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Bakirci EM, Degirmenci H, Duman H, Demirelli S, Hamur H, Buyuklu M, Ceyhun G, Kutlusoy E. Aortic propagation velocity in the prediction of coronary artery disease severity. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2021; 166:51-56. [PMID: 33612836 DOI: 10.5507/bp.2021.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/07/2021] [Indexed: 11/23/2022] Open
Abstract
AIMS To investigate the association of the aortic propagation velocity (APV) with coronary artery disease (CAD) in patients with stable angina pectoris (SAP) through SYNTAX scores (SS). METHODS The study population comprised 214 SAP subjects who received a coronary angiography. The APV and carotid intima-media thickness (CIMT) were examined and SS was calculated. Subjects were grouped following specific SS criteria: SS less than 22 (low) and SS greater than or equal to 22 (high). RESULTS High SS subjects had lower APV compared to low SS [39.0 (32.0-51.7) vs. 55.0 (45.0-62.0) cm/s, respectively; P<0.001] and higher CIMT (0.86 ± 0.24 vs. 0.74 ± 0.21 mm, respectively; P<0.001). APV demonstrated a negative correlation with the CIMT (r=-0.239, P<0.001), age (r=-0.188, P=0.006) , and SS (r=-0.561, P <0.001) and showed a positive association with LV ejection fraction (r=0.163, P=0.017). APV, CIMT, diabetes, low-density lipoprotein cholesterol (LDL-C), and age were determined to be markers independently of a high SS. CONCLUSION APV, CIMT, diabetes, LDL-C and age are independently linked to the CAD severity of SAP subjects. Decreased APV, an indicator of subclinical atherosclerosis, may independently help determine the severity of atherosclerotic CAD in SAP patients.
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Affiliation(s)
- Eftal Murat Bakirci
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Husnu Degirmenci
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Hakan Duman
- Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Selami Demirelli
- Department of Cardiology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Hikmet Hamur
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Mutlu Buyuklu
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
| | - Gokhan Ceyhun
- Department of Cardiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Ergun Kutlusoy
- Department of Cardiology, Faculty of Medicine, Erzincan Binali Yildirim University, Erzincan, Turkey
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2
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Song JY, Choi JB, Kim JH, Kim KH, Kim TY. Aortic Arch Endarterectomy Associated with On-Pump Cardiac Surgery in Patients with a Mobile Arch Atheroma. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:112-115. [PMID: 31089450 PMCID: PMC6493261 DOI: 10.5090/kjtcs.2019.52.2.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/03/2018] [Accepted: 10/16/2018] [Indexed: 11/16/2022]
Abstract
We describe aortic arch endarterectomy performed concomitantly with on-pump cardiac surgery in 2 patients with grade V arch atherosclerosis. In both patients, transesophageal echocardiographic findings led to the diagnosis of severe arch atherosclerosis associated with a mobile atheromatous plaque in the aortic arch. The severe arch atherosclerosis was managed with endarterectomy under deep hypothermic circulatory arrest. In patients with severe grade V atherosclerosis in the aortic arch, performing endarterectomy simultaneously with primary cardiac surgery may be justified as a way to reduce the risk of peripheral embolism, including cerebrovascular accidents, with minimal additional surgical risk.
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Affiliation(s)
- Joon Young Song
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Jong Bum Choi
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Jong Hun Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Kyung Hwa Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Tae Yun Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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3
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Tosun V, Güntekin Ü, Şimşek H, Kandemir YB. Aortic-flow propagation velocity is associated with proteinuria and left ventricular hypertrophy in newly diagnosed hypertensive patients. Echocardiography 2019; 36:328-335. [PMID: 30605931 DOI: 10.1111/echo.14239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 11/27/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Subclinical target organ damage (TOD) is an important long-term complication of hypertension and is associated with cardiovascular events and death. Aortic-flow propagation velocity (APV) is one of the arterial stiffness parameters. The aim of this study was to investigate the predictive value of APV on left ventricular hypertrophy (LVH) and proteinuria. METHODS A total of 149 newly diagnosed HT patients were included in the study. Urine samples and blood tests were obtained from each patient for diagnosis of proteinuria. All patients underwent echocardiographic examination. All patients' APV measurements, carotid intima-media thicknesses (CIMT), and ankle-brachial indexes (ABI) were measured and recorded. RESULTS The LVH (+) group consisted of 47 patients, and the LVH (-) group consisted of 102 patients. The proteinuria (+) group consisted of 32 patients, and the proteinuria (-) group consisted of 117 patients. Average CIMT was significantly higher in both proteinuria (+) and LVH (+) groups compared with the (-) groups. ABI and APV were significantly lower in both proteinuria (+) and LVH (+) groups compared with the (-) groups. APV was negatively correlated with LVH, proteinuria, and CIMT and positively correlated with ABI. In the multivariate binary logistic regression analysis, APV was the significant independent predictor of proteinuria. Additionally, APV and ABI were found to be independent predictors of LVH or/and proteinuria. CONCLUSION Hypertensive patients who had TOD had worse consequences of APV, CIMT, and ABI. APV had a powerful predictive value to identify the patients with higher risk of TOD among newly diagnosed hypertensive patients.
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Affiliation(s)
- Veysel Tosun
- Department of Cardiology, Şanlıurfa Education and Research Hospital, Şanlıurfa, Turkey
| | - Ünal Güntekin
- Faculty of Medicine, Department of Cardiology, Akdeniz University, Antalya, Turkey
| | - Hakkı Şimşek
- Faculty of Medicine, Department of Cardiology, Dicle University, Diyarbakır, Turkey
| | - Yasemin B Kandemir
- Faculty of Medicine, Department of Anatomy, Akdeniz University, Antalya, Turkey
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Karaman K, Arisoy A, Altunkas A, Erken E, Demirtas A, Ozturk M, Karayakali M, Sahin S, Celik A. Aortic Flow Propagation Velocity in Patients with Familial Mediterranean Fever: an Observational Study. Korean Circ J 2017; 47:483-489. [PMID: 28765740 PMCID: PMC5537150 DOI: 10.4070/kcj.2016.0400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/03/2017] [Accepted: 03/11/2017] [Indexed: 11/18/2022] Open
Abstract
Background and Objectives Systemic inflammation has an important role in the initiation of atherosclerosis, which is associated with arterial stiffness (AS). Aortic flow propagation velocity (APV) is a new echocardiographic parameter of aortic stiffness. The relationship between systemic inflammation and AS has not yet been described in patients with familial Mediterranean fever (FMF). We aimed to investigate the early markers of AS in patients with FMF by measuring APV and carotid intima-media thickness (CIMT). Subjects and Methods Sixty-one FMF patients (43 women; mean age 27.3±6.7 years) in an attack-free period and 57 healthy individuals (36 women; mean age 28.8±7.1 years) were included in this study. The individuals with atherosclerotic risk factors were excluded from the study. The flow propagation velocity of the descending aorta and CIMT were measured to assess AS. Results APV was significantly lower (60.2±16.5 vs. 89.5±11.6 cm/sec, p<0.001) and CIMT was significantly higher (0.49±0.09 vs. 0.40±0.10 mm, p<0.001) in the FMF group compared to the control group. There were significant correlations between APV and mean CIMT (r=-0.424, p<0.001), erythrocyte sedimentation rate (ESR) (r=-0.198, p=0.032), and left ventricle ejection fraction (r=0.201, p=0.029). APV and the ESR were independent predictors of FMF in logistic regression analysis (OR=-0.900, 95% CI=0.865-0.936, p<0.001 and OR=-1.078, 95% CI=1.024-1.135, p=0.004, respectively). Mean CIMT and LVEF were independent factors associated with APV in linear regression analysis (β=-0.423, p<0.001 and β=0.199, p=0.017, respectively). Conclusion We demonstrated that APV was lower in FMF patients and is related to CIMT. According to our results, APV may be an independent predictor of FMF.
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Affiliation(s)
- Kayihan Karaman
- Department of Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Arif Arisoy
- Department of Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Aysegul Altunkas
- Department of Radiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Ertugrul Erken
- Department of Internal Medicine, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Ahmet Demirtas
- Department of Internal Medicine, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Mustafa Ozturk
- Department of Cardiology, Erzurum Territorial Training and Research Hospital, Erzurum, Turkey
| | - Metin Karayakali
- Department of Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Safak Sahin
- Department of Internal Medicine, Gaziosmanpasa University School of Medicine, Tokat, Turkey
| | - Atac Celik
- Department of Cardiology, Gaziosmanpasa University School of Medicine, Tokat, Turkey
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Vasudeva Chetty P, Rajasekhar D, Vanajakshamma V, Ranganayakulu KP, Kranthi Chaithanya D. Aortic velocity propagation: A novel echocardiographic method in predicting atherosclerotic coronary artery disease burden. J Saudi Heart Assoc 2017; 29:176-184. [PMID: 28652671 PMCID: PMC5475356 DOI: 10.1016/j.jsha.2016.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 10/02/2016] [Accepted: 10/13/2016] [Indexed: 11/26/2022] Open
Abstract
Background The major burden of cardiovascular disease mortality around the globe is due to atherosclerosis and its complications. Hence its early detection and management with easily accessible and noninvasive methods are valuable. Aortic velocity propagation (AVP) through color M-mode of the proximal descending aorta determines aortic stiffness, reflecting atherosclerosis. The aim of this study was to find the utility of AVP in predicting coronary artery disease (CAD) burden assessed through SYNTAX (SYNergy between percutaneous coronary intervention with TAXus and cardiac surgery) score and compared with carotid intima-media thickness (CIMT), which is an established surrogate marker of atherosclerosis. Methods In this cross-sectional comparative study, we measured AVP by color M-mode and CIMT by using Philips QLAB-IMT software in 100 patients, who underwent conventional coronary angiogram (CAG) between May 2013 and November 2014. Coronary artery disease is considered significant if >50% diameter stenosis is present in any epicardial coronary artery and insignificant if otherwise. Results Initially, to know the normal range we measured AVP and CIMT in 50 patients without any major risk factors for CAD but CAG was not done. Aortic velocity propagation ranged from 46 cm/s to 76 cm/s (mean = 58.62 ± 6.46 cm/s), CIMT ranged from 0.50 mm to 0.64 mm (mean = 0.55 ± 0.03 mm). Among 100 patients who underwent CAG we found 69% had significant CAD, 13% had insignificant CAD, and 18% had normal coronaries. Those with significant CAD had significantly lower AVP (41.65 ± 4.94 cm/s) [F (2,97) = 44.05, p < 0.0001] and significantly higher CIMT (0.86 ± 0.11 mm) [F (2,97) =35.78, p < 0.0001]. AVP had significant strong negative correlation with CIMT (r = −0.836, p < 0.0001, n = 100) and SYNTAX score (r = –0.803, p < 0.0001, n = 69), while CIMT was positively correlated with SYNTAX score significantly (r = 0.828, p < 0.0001, n = 69). Conclusions AVP and CIMT can predict CAD burden in a robust way. AVP may emerge as an exquisite bedside tool to predict atherosclerotic burden and guide in implementing preventive therapy for cardiovascular disease.
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Affiliation(s)
- Pakala Vasudeva Chetty
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, IndiaaIndia
| | - Durgaprasad Rajasekhar
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, IndiaaIndia
| | - Velam Vanajakshamma
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, IndiaaIndia
| | | | - Dommara Kranthi Chaithanya
- Department of Cardiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, IndiaaIndia
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Imaging Techniques for Diagnosis of Thoracic Aortic Atherosclerosis. Int J Vasc Med 2016; 2016:4726094. [PMID: 26966580 PMCID: PMC4757718 DOI: 10.1155/2016/4726094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/13/2016] [Indexed: 12/22/2022] Open
Abstract
The most severe complications after cardiac surgery are neurological complications including stroke which is often caused by emboli merging from atherosclerosis in the ascending aorta to the brain. Information about the thoracic aorta is crucial in reducing the embolization risk for both surgical open and closed chest procedures such as transaortic heart valve implantation. Several techniques are available to screen the ascending aorta, for example, transesophageal echocardiography (TEE), epiaortic ultrasound, TEE A-view method, manual palpation, computed tomography, and magnetic resonance imaging. This paper provides a description of the advantages and disadvantages of these imaging techniques.
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7
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Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015; 28:119-82. [DOI: 10.1016/j.echo.2014.11.015] [Citation(s) in RCA: 409] [Impact Index Per Article: 45.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Vizzardi E, D'Aloia A, Sciatti E, Bonadei I, Gelsomino S, Lorusso R, Metra M. Echocardiographic evaluation of aortic atheromas in patients with aortic stenosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:105-110. [PMID: 25542945 DOI: 10.7863/ultra.34.1.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES The association of aortic atheromas in patients with isolated aortic stenosis has recently been acknowledged, probably because the pathogenic mechanisms are similar. Therefore, this study evaluated the extent and severity of thoracic aortic atheromas in patients with different grades of aortic stenosis using transesophageal echocardiography. METHODS We retrospectively evaluated transesophageal echocardiographic examinations of 686 consecutive patients with a diagnosis of aortic stenosis. The prevalence and morphologic characteristics of atheromas in 3 segments of the thoracic aorta were assessed. Plaque thickness was measured at each segment, and the thickest plaque was used to establish severity. Atheromas were graded as mild, moderate, or severe according to plaque thickness (<2, 2-4, or >4 mm, respectively). Aortic stenosis was graded as mild, moderate, or severe on the basis of the gradient and anatomic aortic valve area (>1.5, 1.0-1.5, or <1.0 cm(2)). RESULTS A total of 382 patients were men, and 304 were women (mean age ± SD, 74 ± 15 years); 86% of the patients had aortic atheromas. The severe stenosis group had a significantly higher rate of atheromas (95% versus 40%; P < .001) than the mild stenosis group, with more complex atheromas (52% versus 22%; P< .001). There was no significant difference in the atheroma grades between the severe and moderate stenosis groups, but moderate cases had more moderate and severe atheromas than mild cases (45% and 15% versus 19% and 3%; P < .01). CONCLUSIONS This study showed a correlation in the extent of aortic atheromas across several degrees of aortic stenosis. Patients with moderate and severe stenosis had more extensive atherosclerotic atheromas than those with mild stenosis.
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Affiliation(s)
- Enrico Vizzardi
- From the Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy (E.V., A.D., E.S., I.B., M.M.); Heart and Vessels Department, Careggi Hospital, Florence, Italy (S.G.); and Experimental Cardiac Surgery Laboratory, Cardiac Surgery Unit, Civil Hospital, Brescia, Italy (R.L.).
| | - Antonio D'Aloia
- From the Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy (E.V., A.D., E.S., I.B., M.M.); Heart and Vessels Department, Careggi Hospital, Florence, Italy (S.G.); and Experimental Cardiac Surgery Laboratory, Cardiac Surgery Unit, Civil Hospital, Brescia, Italy (R.L.)
| | - Edoardo Sciatti
- From the Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy (E.V., A.D., E.S., I.B., M.M.); Heart and Vessels Department, Careggi Hospital, Florence, Italy (S.G.); and Experimental Cardiac Surgery Laboratory, Cardiac Surgery Unit, Civil Hospital, Brescia, Italy (R.L.)
| | - Ivano Bonadei
- From the Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy (E.V., A.D., E.S., I.B., M.M.); Heart and Vessels Department, Careggi Hospital, Florence, Italy (S.G.); and Experimental Cardiac Surgery Laboratory, Cardiac Surgery Unit, Civil Hospital, Brescia, Italy (R.L.)
| | - Sandro Gelsomino
- From the Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy (E.V., A.D., E.S., I.B., M.M.); Heart and Vessels Department, Careggi Hospital, Florence, Italy (S.G.); and Experimental Cardiac Surgery Laboratory, Cardiac Surgery Unit, Civil Hospital, Brescia, Italy (R.L.)
| | - Roberto Lorusso
- From the Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy (E.V., A.D., E.S., I.B., M.M.); Heart and Vessels Department, Careggi Hospital, Florence, Italy (S.G.); and Experimental Cardiac Surgery Laboratory, Cardiac Surgery Unit, Civil Hospital, Brescia, Italy (R.L.)
| | - Marco Metra
- From the Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy (E.V., A.D., E.S., I.B., M.M.); Heart and Vessels Department, Careggi Hospital, Florence, Italy (S.G.); and Experimental Cardiac Surgery Laboratory, Cardiac Surgery Unit, Civil Hospital, Brescia, Italy (R.L.)
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9
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Katsanos AH, Giannopoulos S, Kosmidou M, Voumvourakis K, Parissis JT, Kyritsis AP, Tsivgoulis G. Complex atheromatous plaques in the descending aorta and the risk of stroke: a systematic review and meta-analysis. Stroke 2014; 45:1764-70. [PMID: 24788969 DOI: 10.1161/strokeaha.114.005190] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Proximal aortic plaques, especially in the aortic arch, have already been established as an important cause of stroke and peripheral embolism. However, aortic plaques situated in the descending thoracic aorta have recently been postulated as a potential embolic source in patients with cryptogenic cerebral infarction through retrograde aortic flow. The aim of the present study was to evaluate the potential association of descending aorta atheromatosis with cerebral ischemia. METHODS We conducted a systematic review and meta-analysis of all available prospective observational studies reporting the prevalence of complex atheromatous plaques in the descending aorta in patients with stroke and in unselected populations undergoing examination with transesophageal echocardiography. RESULTS We identified 11 eligible studies including a total of 4000 patients (667 patients with stroke and 3333 unselected individuals; mean age, 65 years; 55% men). On baseline transesophageal echocardiograpic examination, the prevalence of complex atheromatous plaques in the descending aorta was higher (P=0.001) in patients with stroke (25.4%; 95% confidence interval, 14.6-40.4%) compared with unselected individuals (6.1%; 95% confidence interval, 3.4-10%). However, no significant difference (P=0.059) in the prevalence of complex atheromatous plaques in the descending aorta was found between patients with cryptogenic (21.8%; 95% confidence interval, 17.5-26.9%) and unclassified (28.3%; 95% confidence interval, 23.9-33.1%) cerebral infarction. CONCLUSIONS Our findings indicate that the presence of complex plaques in the descending aorta is presumably a marker of generalized atherosclerosis and high vascular risk. The present analyses do not provide any further evidence for a direct causal relationship between descending aorta atherosclerosis and cerebral embolism.
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Affiliation(s)
- Aristeidis H Katsanos
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and First Division of Internal Medicine (M.K.), School of Medicine, University of Ioannina, Ioannina, Greece; Second Department of Neurology (K.V., G.T.) and Second Department of Cardiology (J.T.P.), Attikon Hospital, School of Medicine, University of Athens, Athens, Greece; and International Clinical Research Center, Department of Neurology, St Anne's University Hospital in Brno, Brno, Czech Republic (G.T.)
| | - Sotirios Giannopoulos
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and First Division of Internal Medicine (M.K.), School of Medicine, University of Ioannina, Ioannina, Greece; Second Department of Neurology (K.V., G.T.) and Second Department of Cardiology (J.T.P.), Attikon Hospital, School of Medicine, University of Athens, Athens, Greece; and International Clinical Research Center, Department of Neurology, St Anne's University Hospital in Brno, Brno, Czech Republic (G.T.)
| | - Maria Kosmidou
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and First Division of Internal Medicine (M.K.), School of Medicine, University of Ioannina, Ioannina, Greece; Second Department of Neurology (K.V., G.T.) and Second Department of Cardiology (J.T.P.), Attikon Hospital, School of Medicine, University of Athens, Athens, Greece; and International Clinical Research Center, Department of Neurology, St Anne's University Hospital in Brno, Brno, Czech Republic (G.T.)
| | - Konstantinos Voumvourakis
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and First Division of Internal Medicine (M.K.), School of Medicine, University of Ioannina, Ioannina, Greece; Second Department of Neurology (K.V., G.T.) and Second Department of Cardiology (J.T.P.), Attikon Hospital, School of Medicine, University of Athens, Athens, Greece; and International Clinical Research Center, Department of Neurology, St Anne's University Hospital in Brno, Brno, Czech Republic (G.T.)
| | - John T Parissis
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and First Division of Internal Medicine (M.K.), School of Medicine, University of Ioannina, Ioannina, Greece; Second Department of Neurology (K.V., G.T.) and Second Department of Cardiology (J.T.P.), Attikon Hospital, School of Medicine, University of Athens, Athens, Greece; and International Clinical Research Center, Department of Neurology, St Anne's University Hospital in Brno, Brno, Czech Republic (G.T.)
| | - Athanassios P Kyritsis
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and First Division of Internal Medicine (M.K.), School of Medicine, University of Ioannina, Ioannina, Greece; Second Department of Neurology (K.V., G.T.) and Second Department of Cardiology (J.T.P.), Attikon Hospital, School of Medicine, University of Athens, Athens, Greece; and International Clinical Research Center, Department of Neurology, St Anne's University Hospital in Brno, Brno, Czech Republic (G.T.)
| | - Georgios Tsivgoulis
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and First Division of Internal Medicine (M.K.), School of Medicine, University of Ioannina, Ioannina, Greece; Second Department of Neurology (K.V., G.T.) and Second Department of Cardiology (J.T.P.), Attikon Hospital, School of Medicine, University of Athens, Athens, Greece; and International Clinical Research Center, Department of Neurology, St Anne's University Hospital in Brno, Brno, Czech Republic (G.T.).
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Hueb JC, Bazan R, Pereira Braga G, Fusco DR, Zanati Bazan SG, Bojikian Matsubara B. Carotid artery atherosclerotic profile as a predictor of the aorta atherosclerotic profile in patients with cerebrovascular events. Cerebrovasc Dis 2013; 36:26-32. [PMID: 23920380 DOI: 10.1159/000351150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 03/26/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND It is well known that the presence of atheroma of the thoracic aorta is a risk factor for cerebrovascular events. We sought to evaluate whether the presence and the morphology of atherosclerotic plaque in the carotid artery detected by duplex ultrasonography is associated with disease in the proximal aorta visualized by transesophageal echocardiogram in patients with a cerebrovascular event. METHODS We carried out a cross-sectional prospective study including 147 consecutive patients with prior stroke or transient ischemic attack (TIA). Neurological evaluations were performed by an expert neurologist using clinical and tomographic diagnostic criteria including the definition of etiology and whether the patient suffered from stroke or TIA. Transthoracic and transesophageal echocardiograms and carotid artery duplex ultrasonography were performed by the same examiner. Patients with and without plaque in the carotid artery were compared using Student's t test or the χ2 test. Regression analysis was used to determine whether the presence of plaque in the carotid artery was predictive of the presence of plaque in the proximal aorta and to analyze the relationship between the echogenicity of carotid and aortic plaques. The significance level was set at p < 0.05. RESULTS All 147 patients (95 men) were included in the analysis. Patients' ages ranged from 23 to 85 years (65 ± 12.4 years). Most of the patients (58.5%) were Caucasian, while 41.5% were African-Brazilian. Arterial hypertension, diabetes and tobacco use were more frequent among patients with atherosclerotic plaque in the aorta. A normal carotid intima-media thickness halved the risk of atherosclerotic plaque in the aorta [odds ratio (OR) 0.46, 95% confidence interval (CI) 0.23-0.91; p = 0.026]. The presence of carotid plaque increased the risk of aortic plaque by 70-fold (OR 73.2, 95% CI 25.6-2,018.6; p < 0.001) in univariate analysis. The absence of atherosclerotic plaque in the carotid artery reduced the risk of plaque in the aorta to almost 0 (OR 0.014, 95% CI 0.004-0.041; p < 0.001). Considering the 86 patients with both aortic and carotid plaques, the presence of hypoechoic plaque in the carotid artery was a predictor of hypoechoic plaque in the aorta (OR 10.1, 95% CI 3.3-31.2; p < 0.001). CONCLUSIONS The carotid artery atherosclerotic profile defined by ultrasonography is a strong predictor of the atherosclerotic profile of the proximal aorta. This should be taken into consideration before referring patients with acute cerebrovascular events for transesophageal echocardiogram.
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Affiliation(s)
- João Carlos Hueb
- Department of Internal Medicine, Botucatu Medical School - Universidade Estadual Paulista, São Paulo State University, São Paulo, Brazil
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11
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Feasibility of TEE-guided stroke risk assessment in atrial fibrillation-background, aims, design and baseline data of the TIARA pilot study. Neth Heart J 2013; 19:214-22. [PMID: 21541835 PMCID: PMC3087029 DOI: 10.1007/s12471-011-0095-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Antithrombotic management in atrial fibrillation (AF) is currently based on clinical characteristics, despite evidence of potential fine-tuning with transoesophageal echocardiography (TEE). This open, randomised, multicentre study addresses the hypothesis that a comprehensive strategy of TEE-based aspirin treatment in AF patients is feasible and safe. Methods Between 2005 and 2009, ten large hospitals in the Netherlands enrolled AF patients with a moderate risk of stroke. Patients without thrombogenic TEE characteristics were randomised to aspirin or vitamin K antagonists (VKA). The primary objective is to show that TEE-based aspirin treatment is safe compared with VKA therapy. The secondary objective tests feasibility of TEE as a tool to detect echocardiographic features of high stroke risk. This report compares randomised to non-randomised patients and describes the feasibility of a TEE-based approach. Results In total, 310 patients were included. Sixty-nine patients were not randomised because of non-visualisation (n = 6) or TEE risk factors (n = 63). Compared with non-randomised patients, randomised patients (n = 241) were younger (65 ± 11 vs. 69 ± 9 years, p = 0.004), had less coronary artery disease (9 vs. 20%, p = 0.018), previous TIA (1.7 vs. 7.2%, p = 0.029), AF during TEE (25 vs. 54%, p < 0.001), mitral incompetence (55 vs. 70%, p = 0.038), VKA use (69 vs. 82%, p = 0.032), had a lower mean CHADS2 score (1.2 ± 0.6 vs. 1.6 ± 1.0, p = 0.004), and left ventricular ejection fraction (59 ± 8 vs. 56 ± 8%, p = 0.016). Conclusions This study shows that a TEE-based approach for fine-tuning stroke risk in AF patients with a moderate risk for stroke is feasible. Follow-up data will address the safety of this TEE-based approach.
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12
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An echo-guided case report of rapid regression of unstable mobile thrombus aortic atheroma after aggressive statin and antiplatelet combination therapy. Am J Ther 2013; 21:e61-5. [PMID: 23817345 DOI: 10.1097/mjt.0b013e3182459943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We describe a case report that documented the efficacy and safety of medical therapy in stabilizing and resolving a complex and unstable aortic atheroma after a relatively short period. The patient had a large protruding, mobile, calcified nonulcerated atheroma involving the descending aorta and was therefore treated with aggressive combination therapy with high statin dosages (atorvastatin = 80 mg) and dual antiplatelet treatment (clopidogrel = 75 mg and aspirin = 100 mg). At follow-up, the echocardiogram showed a significant regression in the atheroma volume, with no signs suggestive of ulceration on its surface with the complete mobile component resolution.
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Simsek H, Sahin M, Gunes Y, Dogan A, Gumrukcuoglu HA, Tuncer M. A Novel Echocardiographic Method for the Detection of Subclinical Atherosclerosis in Newly Diagnosed, Untreated Type 2 Diabetes. Echocardiography 2013; 30:644-8. [DOI: 10.1111/echo.12125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hakki Simsek
- Cardiology Department; Yuzunci Yil University; Faculty of Medicine; Van; Turkey
| | - Musa Sahin
- Cardiology Department; Yuzunci Yil University; Faculty of Medicine; Van; Turkey
| | - Yilmaz Gunes
- Cardiology Department; Hisar Intercontinental Hospital; Istanbul; Turkey
| | - Adnan Dogan
- Cardiology Department; Dumlupinar University; Faculty of Medicine; Kutahya; Turkey
| | | | - Mustafa Tuncer
- Cardiology Department; Yuzunci Yil University; Faculty of Medicine; Van; Turkey
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Faber T, Rippy A, Hyslop WB, Hinderliter A, Sen S. Cardiovascular MRI in Detection and Measurement of Aortic Atheroma in Stroke/TIA patients. ACTA ACUST UNITED AC 2013; 1:139. [PMID: 24851233 PMCID: PMC4025943 DOI: 10.4172/2329-6895.1000139] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Aortic Atheroma (AoA) is an independent risk factor for new and recurrent stroke. AoA ulceration and mobility are associated with an increased risk for brain embolism. Transesophageal echocardiography (TEE) is the gold standard for detection and measurement of AoA in stroke/TIA patients. Cardiovascular MRI (cMRI) could be an alternative, non-invasive imaging modality for stroke/TIA patients. The objective of this study was to assess the accuracy and correlation of AoA detected and measured by cMRI versus TEE in patients with recent stroke/TIA. Methods and results Twenty-two stroke/TIA patients undergoing TEE as a part of their stroke workup consented to a protocol-mandated cMRI performed on a 1.5 T magnet. The protocol included an axial non-breathhold EKG-gated dual-echo spin echo MRI of the thoracic aorta (TR/TE1/TE2=900/29/69) and a contrast-enhanced breathhold 3D gradient-echo image of the thorax (flip/TR/TE=12/4.0/1.71). Maximum plaque thickness, ulceration (≥ 2 mm) and mobility of AoA were assessed in the proximal (ascending and proximal arch) and distal (distal arch and descending) segments of thoracic aorta by a cardiologist to interpret the TEE and a radiologist to interpret the cMRI. There was good correlation between cMRI and TEE in measurement of plaque thickness in the proximal segments (R=0.73, p<0.0001) and the distal segments (R=0.81, p<0.0001) of the aortic arch (AA). cMRI had a high degree of accuracy in detecting measurable AoA (≥ 1 mm) in the proximal segments (sensitivity 90%, specificity 100%), as well as the distal segments (sensitivity 67%, specificity 100%). cMRI also had a high degree of accuracy in detecting significant AoA (≥ 4 mm) in proximal segments (sensitivity 71%, specificity 93%), as well as distal segments (sensitivity 71%, specificity 100%). Conclusion The study showed a high degree of accuracy and correlation of AoA detected and measured by cMRI as compared to TEE in patients with recent stroke/TIA. This technique has limitations in detection of AoA ulceration, and protocols assessing AoA mobility need to be developed.
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Affiliation(s)
- Theodore Faber
- University of South Carolina School of Medicine, Department of Neurology, Columbia, South Carolina, USA
| | - Ashley Rippy
- University of South Carolina School of Medicine, Department of Neurology, Columbia, South Carolina, USA
| | - W Brian Hyslop
- University of North Carolina School of Medicine, Department of Radiology and Cardiology, Chapel Hill, North Carolina, USA
| | - Alan Hinderliter
- University of North Carolina School of Medicine, Department of Radiology and Cardiology, Chapel Hill, North Carolina, USA
| | - Souvik Sen
- University of South Carolina School of Medicine, Department of Neurology, Columbia, South Carolina, USA
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Watari M, Nakajima M, Nishitomi-Izumida M, Inatomi Y, Yonehara T, Hirano T. Dynamic migration of a mobile plaque from the brachiocephalic artery detected by ultrasonography. Echocardiography 2012; 30:E28-9. [PMID: 23002794 DOI: 10.1111/j.1540-8175.2012.01823.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mari Watari
- Department of Neurology, Stroke Center, Saiseikai Kumamoto Hospital, Kumamoto, Japan
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Sharma U, Tak T. Aortic Atheromas: Current Knowledge and Controversies: A Brief Review of the Literature. Echocardiography 2011; 28:1157-63. [DOI: 10.1111/j.1540-8175.2011.01478.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Inanc MT, Kalay N, Heyit T, Ozdogru I, Kaya MG, Dogan A, Duran M, Kasapkara HA, Gunebakmaz O, Borlu M, Yarlıoglues M, Oguzhan A. Effects of atorvastatin and lisinopril on endothelial dysfunction in patients with Behçet's disease. Echocardiography 2011; 27:997-1003. [PMID: 20545993 DOI: 10.1111/j.1540-8175.2010.01180.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Behçet's disease is a chronic inflammatory vasculitis. Vascular involvement is one of the major complications of Behçet's disease, during the course of the disease. Previous studies showed that ACE inhibitors and statins may improve endothelial functions in endothelial dysfunction. The aim of our study is to compare the effects of atorvastatin and lisinopril to placebo on endothelial dysfunction in patients with Behçet's disease. PATIENTS AND METHODS We prospectively studied 92 (48 female) Behçet's patients who were diagnosed according to the International Study Group criteria. Endothelial dysfunction was evaluated by brachial artery flow-mediated dilatation (FMD) method using high-resolution vascular ultrasound device at baseline and after for 3-month therapy. Patients were consecutively randomized into three groups as (atorvastatin (n = 31), lisinopril (n = 31), and placebo groups (n = 30). Patients in atorvastatin group received 20 mg atorvastatin, lisinopril group received 10 mg lisinopril per day, and placebo group received placebo per day for 3 months. RESULTS The baseline characteristics of patients were similar among three groups; however, high-sensitive C-reactive protein (hs-CRP) levels were lower in atorvastatin group than placebo group. A significant improvement in FMD was observed in both atorvastatin (5.0 ± 1.4 vs. 12.8 ± 3.6%, P < 0.001) and lisinopril groups (5.0 ± 1.2 vs. 11.4 ± 5.0%, P < 0.001). Partial significant enhancement was observed in placebo group (4.9 ± 1.1% vs. 5.7 ± 1.0, P = 0.002). However, it was lower than the cutoff value for endothelial dysfunction. CONCLUSION These findings suggest that atorvastatin and lisinopril improve endothelial functions in Behçet's disease patients. However, large studies are needed to determine the long-term effects of atorvastatin and lisinopril therapy.
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Combined Assessment of Aortic Root Anatomy and Aortoiliac Vasculature With Dual-Source CT as a Screening Tool in Patients Evaluated for Transcatheter Aortic Valve Implantation. AJR Am J Roentgenol 2010; 195:872-81. [DOI: 10.2214/ajr.10.4232] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Gunes Y, Tuncer M, Guntekin U, Ceylan Y, Simsek H, Sahin M, Yildirim M. The relation between the color M-mode propagation velocity of the descending aorta and coronary and carotid atherosclerosis and flow-mediated dilatation. Echocardiography 2010; 27:300-5. [PMID: 20486958 DOI: 10.1111/j.1540-8175.2009.01019.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To improve clinical outcomes, noninvasive imaging modalities have been proposed to measure and monitor atherosclerosis. Common carotid intima-media thickness (CIMT) and brachial artery flow-mediated dilatation (FMD) have correlated with coronary atherosclerosis. Recently, the color M-mode-derived propagation velocity of descending thoracic aorta (AVP) was shown to be associated with coronary artery disease (CAD). METHODS CIMT, FMD, and AVP were measured in 92 patients with CAD and 70 patients having normal coronary arteries (NCA) detected by coronary angiography. Patients with acute myocardial infarction, renal failure or hepatic failure, aneurysm of aorta, severe valvular heart disease, left ventricular ejection fraction <40%, atrial fibrillation, frequent premature beats, left bundle branch block, and inadequate echocardiographic image quality were excluded. RESULTS Compared to patients with normal coronary arteries, patients having CAD had significantly lower AVP (29.9 +/- 8.1 vs. 47.5 +/- 16.8 cm/sec, P < 0.001) and FMD (5.3 +/- 1.9 vs. 11.4 +/- 5.8%, P < 0.001) and higher CIMT (0.94 +/- 0.05 vs. 0.83 +/- 0.14 mm, P < 0.001) measurements. There were significant correlations between AVP and CIMT (r =-0.691, P < 0.001), AVP and FMD (r = 0.514, P < 0.001) and FMD and CIMT (r =-0.530, P < 0.001). CONCLUSIONS The transthoracic echocardiographic determination of the color M-mode propagation velocity of the descending aorta is a simple practical method and correlates well with the presence of carotid and coronary atherosclerosis and brachial endothelial function.
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Affiliation(s)
- Yilmaz Gunes
- Cardiology Department, Faculty of Medicine, Yuzuncu Yil University, Van, Turkey. mail:
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Evangelista A, Flachskampf FA, Erbel R, Antonini-Canterin F, Vlachopoulos C, Rocchi G, Sicari R, Nihoyannopoulos P, Zamorano J, Pepi M, Breithardt OA, Plonska-Gosciniak E. Echocardiography in aortic diseases: EAE recommendations for clinical practice. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:645-58. [PMID: 20823280 DOI: 10.1093/ejechocard/jeq056] [Citation(s) in RCA: 316] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Arturo Evangelista
- Servei de Cardiologia, Hospital Vall d'Hebron, P degrees Vall d'Hebron 119, 08035 Barcelona, Spain.
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Haruki N, Takeuchi M, Kaku K, Yoshitani H, Tamura M, Abe H, Okazaki M, Ota T, Otsuji Y. Prevalence and Clinical Implication of Complex Atherosclerotic Plaque in the Descending Thoracic Aorta of Japanese Patients Assessed by Transesophageal Echocardiography. Circ J 2010; 74:2627-32. [DOI: 10.1253/circj.cj-10-0288] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Nobuhiko Haruki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Masaaki Takeuchi
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Kyoko Kaku
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Hidetoshi Yoshitani
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Masahito Tamura
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Haruhiko Abe
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Masahiro Okazaki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Toshiyuki Ota
- Department of Laboratory and Transfusion Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
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Aortic thromboembolism successfully treated with anticoagulation and antiplatelet therapy. Am J Med 2009; 122:e3-4. [PMID: 19958875 DOI: 10.1016/j.amjmed.2009.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 06/08/2009] [Accepted: 06/16/2009] [Indexed: 11/22/2022]
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Frazin LJ, Glowney JW. Mobile Ascending Aortic Atheroma Diagnosed by Transesophageal Echocardiography as Source of Peripheral Vascular Embolism. J Am Soc Echocardiogr 2009; 22:972.e1-4. [DOI: 10.1016/j.echo.2009.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Indexed: 10/20/2022]
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