Document Detail

Extent of thoracic aortic atheroma burden and long-term mortality after cardiothoracic surgery: a computed tomography study.
MedLine Citation:
PMID:  20947047     Owner:  NLM     Status:  MEDLINE    
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.
BACKGROUND: 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.
Vikram Kurra; Michael L Lieber; Srikanth Sola; Vidyasagar Kalahasti; Donald Hammer; Stephen Gimple; Scott D Flamm; Michael A Bolen; Sandra S Halliburton; Tomislav Mihaljevic; Milind Y Desai; Paul Schoenhagen
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  3     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-10-15     Completed Date:  2011-02-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1020-9     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Imaging Institute, Cleveland Clinic, Cleveland, Ohio 44106, USA.
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MeSH Terms
Aged, 80 and over
Aorta, Thoracic / radiography*
Aortic Diseases / complications,  mortality,  radiography*
Aortography / methods*
Cardiac Surgical Procedures / mortality*
Chi-Square Distribution
Contrast Media / diagnostic use
Coronary Artery Bypass / mortality*
Glomerular Filtration Rate
Heart Valves / surgery*
Kaplan-Meier Estimate
Middle Aged
Peripheral Arterial Disease / complications,  mortality
Plaque, Atherosclerotic / complications,  mortality,  radiography*
Predictive Value of Tests
Proportional Hazards Models
Risk Assessment
Risk Factors
Severity of Illness Index
Time Factors
Tomography, X-Ray Computed*
Treatment Outcome
Reg. No./Substance:
0/Contrast Media

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