Extent of Thoracic Aortic Atheroma Burden and Long-Term Mortality After Cardiothoracic Surgery: A Computed Tomography Study

J Am Coll Cardiol Img. 2010; 3(10):1020-1029

Kurra V, Lieber ML, Sola S, Kalahasti V, Hammer D, Gimple S, Flamm SD, Bolen MA, Halliburton SS, Mihaljevic T, Desai MY, Schoenhagen P

OBJECTIVES: We hypothesized that the extent of aortic atheroma of the entire thoracic aorta, determined by pre-operative multidetector-row computed tomographic angiography (MDCTA), is associated with long-term mortality following nonaortic cardiothoracic surgery. In patients evaluated for cardiothoracic surgery, presence of severe aortic atheroma is associated with adverse short- and long-term post-operative outcome. However, the relationship between aortic plaque burden and mortality remains unknown.

METHODS: We reviewed clinical and imaging data from all patients who underwent electrocardiographic-gated contrast-enhanced MDCTA prior to coronary bypass or valvular heart surgery at our institution between 2002 and 2008. MDCTA studies were analyzed for thickness and circumferential extent of aortic atheroma in 5 segments of the thoracic aorta. A semiquantitative total plaque-burden score (TPBS) was calculated by assigning a score of 1 to 3 to plaque thickness and to circumferential plaque extent. When combined, this resulted in a score of 0 to 6 for each of the 5 segments and, hence, an overall score from 0 to 30. The primary end point was all-cause mortality during long-term follow-up.

RESULTS: A total of 862 patients (71% men, 67.8 years) were included and followed over a mean period of 25 ± 16 months. The mean TPBS was 8.6 (SD: ±6.0). The TPBS was a statistically significant predictor of mortality (p < 0.0001) while controlling for baseline demographics, cardiovascular risk factors, and type of surgery including reoperative status. The estimated hazard ratio for TPBS was 1.08 (95% confidence interval: 1.045 to 1.12). Other independent predictors of mortality were glomerular filtration rate (p = 0.015), type of surgery (p = 0.007), and peripheral artery disease (p = 0.03).

CONCLUSIONS: Extent of thoracic aortic atheroma burden is independently associated with increased long-term mortality in patients following cardiothoracic surgery. Although our data do not provide definitive evidence, they suggest a relationship to the systemic atherosclerotic disease process and, therefore, have important implications for secondary prevention in post-operative rehabilitation programs.

PMID:

2 Responses

  1. Jacobo Kirsch, MD  on October 15th, 2010

    Well designed study by the Cleveland Clinic Group that works as proof of concept of the prognostic utility of aortic plaque burden.
    It also validates what we all commonly see when reviewing CT exams of the chest: that plaque is most common at the arch.

  2. Paul Schoenhagen  on October 16th, 2010

    See also:

    Thoracic aortic calcium versus coronary artery calcium for the prediction of coronary heart disease and cardiovascular disease events.
    Wong ND, Gransar H, Shaw L, Polk D, Moon JH, Miranda-Peats R, Hayes SW, Thomson LE, Rozanski A, Friedman JD, Berman DS.
    JACC Cardiovasc Imaging. 2009 Mar;2(3):319-26.
    PMID: 19356578


Leave a Reply