| Extent of thoracic aortic atheroma burden and long-term mortality after cardiothoracic surgery: a computed tomography study. | |
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MedLine Citation:
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PMID: 20947047 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article |
Journal Detail:
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Title: JACC. Cardiovascular imaging Volume: 3 ISSN: 1876-7591 ISO Abbreviation: JACC Cardiovasc Imaging Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-10-15 Completed Date: 2011-02-02 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101467978 Medline TA: JACC Cardiovasc Imaging Country: United States |
Other Details:
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Languages: eng Pagination: 1020-9 Citation Subset: IM |
Copyright Information:
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Copyright © 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Imaging Institute, Cleveland Clinic, Cleveland, Ohio 44106, USA. |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged 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* Female Glomerular Filtration Rate Heart Valves / surgery* Humans Kaplan-Meier Estimate Male 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 |
| Chemical | |
Reg. No./Substance:
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0/Contrast Media |
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