ATHEROSCLEROSIS OF THE ASCENDING AORTA - PREVALENCE AND ROLE AS AN INDEPENDENT PREDICTOR OF CEREBROVASCULAR EVENTS IN CARDIAC PATIENTS

Background and Purpose The cause of cerebral and peripheral embolism r emains undetermined in a significant number of patients. An atheroscle rotic thoracic aorta has thus far been considered to be an uncommon on e. Methods To define the potential role of the ascending thoracic aort a as an embolic source, intraoperative ultrasonic aortic imaging was p erformed in 1200 of 1334 consecutive patients aged 50 years and older who were undergoing cardiac surgery. Patients were divided into two gr oups according to the results of the ultrasound study in terms of pres ence or absence of atherosclerotic disease. The prevalence of previous neurological events in the two groups was characterized and compared. Results Ascending aortic atherosclerosis was present in 231 (19.3%) o f the patients studied. Patients in this category were older (P<.0001) . A higher percentage of them were smokers (P<.0001) compared with pat ients with less severe disease. Coronary artery disease was more exten sive (P=.012), and a higher percentage of these patients had a history of peripheral vascular disease (P<.0001). Univariate analysis of the subjects with (n=158) and without (n=1042) previous neurological event s indicated that age, body mass index, atrial fibrillation, hypertensi on, and atherosclerosis of the ascending aorta were associated signifi cantly with previous occurrence of a cerebrovascular accident. For the group as a whole, multiple logistic regression analysis demonstrated that hypertension (odds ratio, 1.81; P=.002), atherosclerosis of the a scending aorta (odds ratio, 1.65; P=.013), and atrial fibrillation (od ds ratio, 1.54; P=.060) were significantly and independently associate d with the occurrence of previous neurological events. Conclusions Ath erosclerosis of the ascending aorta is an independent risk factor for cerebrovascular events. An atherosclerotic ascending aorta may represe nt a potential source of emboli or may be a marker of generalized athe rosclerosis.