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Yılar K, Çandır BN, Küçük C, Arpak BB, Özdemir K, Kale A, Coskun O, Gayretli Ö. Calcification And Atheroma Plaques: Is There Any Impact On The Anatomical Features Of The Aortic Root And Its Elements? Cardiovasc Pathol 2024:107655. [PMID: 38777138 DOI: 10.1016/j.carpath.2024.107655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES Morphometric information of the structures within the borders of the aortic root is a guide for surgical interventions. It is essential to determine the effects of aortic calcification and atheroma plaque findings on the structures of this region. This study aims to establish the normal values of aortic root structures and to investigate the impact of pathologic findings in order to guide diagnosis and treatment in the clinic. METHODS The aortic root structures were morphometrically analyzed in fresh hearts of 110 patients (89 males, 21 females) brought to the forensic medicine institution. The distances between the bases of the aortic sinuses, their widths and heights, and the lengths of the commissures were measured to differentiate between pathologic and non-pathologic aortic classes. Parameters were compared according to gender, age, body mass index and body surface area. RESULTS The mean age was 44.71±15.57 years in 21 female patients and 53.66±15.67 years in 89 male patients. The results of the pathologic aorta group with calcification and atheroma plaque findings were higher than the non-pathologic aorta group in all parameters (p<0.05). CONCLUSIONS Calcification and the presence of atheroma plaque in the aorta increase the size of the structures at the aortic root. Gender, age, body mass index and body surface area are among the criteria that will cause changes in the structures of this region. These results will help surgeons to know the normal values of aortic root structures and to consider the effects of pathologic findings in aortic valve repair operations.
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Affiliation(s)
- Kader Yılar
- Department of Anatomy, Faculty of Medicine, Institute of Graduate Studies in Health Sciences, Istanbul University, Istanbul, Turkey; Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University; Istanbul, Turkey.
| | - Buse Naz Çandır
- Department of Anatomy, Faculty of Medicine, Istanbul Yeni Yuzyıl University, Istanbul, Turkey
| | - Ceyhun Küçük
- The Council of Forensic Medicine, Istanbul, Turkey
| | | | - Kemal Özdemir
- Istanbul Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Aysin Kale
- Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University; Istanbul, Turkey
| | - Osman Coskun
- Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University; Istanbul, Turkey
| | - Özcan Gayretli
- Department of Anatomy, Istanbul Faculty of Medicine, Istanbul University; Istanbul, Turkey
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Thong EHE, Kong WKF, Poh KK, Wong R, Chai P, Sia CH. Multimodal Cardiac Imaging in the Assessment of Patients Who Have Suffered a Cardioembolic Stroke: A Review. J Cardiovasc Dev Dis 2023; 11:13. [PMID: 38248883 PMCID: PMC10816708 DOI: 10.3390/jcdd11010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024] Open
Abstract
Cardioembolic strokes account for 20-25% of all ischaemic strokes, with their incidence increasing with age. Cardiac imaging plays a crucial role in identifying cardioembolic causes of stroke, with early and accurate identification affecting treatment, preventing recurrence, and reducing stroke incidence. Echocardiography serves as the mainstay of cardiac evaluation. Transthoracic echocardiography (TTE) is the first line in the basic evaluation of structural heart disorders, valvular disease, vegetations, and intraventricular thrombus. It can be used to measure chamber size and systolic/diastolic function. Trans-oesophageal echocardiography (TOE) yields better results in identifying potential cardioembolic sources of stroke and should be strongly considered, especially if TTE does not yield adequate results. Cardiac computed tomography and cardiac magnetic resonance imaging provide better soft tissue characterisation, high-grade anatomical information, spatial and temporal visualisation, and image reconstruction in multiple planes, especially with contrast. These techniques are useful in cases of inconclusive echocardiograms and can be used to detect and characterise valvular lesions, thrombi, fibrosis, cardiomyopathies, and aortic plaques. Nuclear imaging is not routinely used, but it can be used to assess left-ventricular perfusion, function, and dimensions and may be useful in cases of infective endocarditis. Its use should be considered on a case-by-case basis. The accuracy of each imaging modality depends on the likely source of cardioembolism, and the choice of imaging approach should be tailored to individual patients.
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Affiliation(s)
| | - William K. F. Kong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Raymond Wong
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Ping Chai
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (W.K.F.K.); (K.-K.P.); (R.W.); (P.C.)
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Sakai Y, Cao Q, Rubin J, Witsch J, Cohen‐Addad D, de Macedo Rodrigues K, Coco‐Martin MB, Pasyar P, Juega J, Fan Z, Kasner SE, Cucchiara BL, Song JW. Imaging Biomarkers and Prevalence of Complex Aortic Plaque in Cryptogenic Stroke: A Systematic Review. J Am Heart Assoc 2023; 12:e031797. [PMID: 38014682 PMCID: PMC10727354 DOI: 10.1161/jaha.123.031797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Complex aortic plaque (CAP) is a potential embolic source in patients with cryptogenic stroke (CS). We review CAP imaging criteria for transesophageal echocardiogram (TEE), computed tomography angiography (CTA), and magnetic resonance imaging and calculate CAP prevalence in patients with acute CS. METHODS AND RESULTS PubMed and EMBASE databases were searched up to December 2022 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Two independent reviewers extracted data on study design, imaging techniques, CAP criteria, and prevalence. The Cochrane Collaboration tool and Guideline for Reporting Reliability and Agreement Studies were used to assess risk of bias and reporting completeness, respectively. From 2293 studies, 45 were reviewed for CAP imaging biomarker criteria in patients with acute CS (N=37 TEE; N=9 CTA; N=6 magnetic resonance imaging). Most studies (74%) used ≥4 mm plaque thickness as the imaging criterion for CAP although ≥1 mm (N=1, CTA), ≥5 mm (N=5, TEE), and ≥6 mm (N=2, CTA) were also reported. Additional features included mobility, ulceration, thrombus, protrusions, and assessment of plaque composition. From 23 prospective studies, CAP was detected in 960 of 2778 patients with CS (0.32 [95% CI, 0.24-0.41], I2=94%). By modality, prevalence estimates were 0.29 (95% CI, 0.20-0.40; I2=95%) for TEE; 0.23 (95% CI, 0.15-0.34; I2=87%) for CTA and 0.22 (95% CI, 0.06-0.54; I2=92%) for magnetic resonance imaging. CONCLUSIONS TEE was commonly used to assess CAP in patients with CS. The most common CAP imaging biomarker was ≥4 mm plaque thickness. CAP was observed in one-third of patients with acute CS. However, high study heterogeneity suggests a need for reproducible imaging methods.
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Affiliation(s)
- Yu Sakai
- Department of RadiologyUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Quy Cao
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Jeremy Rubin
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Jens Witsch
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Dan Cohen‐Addad
- Department of Radiology and Imaging SciencesEmory UniversityAtlantaGAUSA
| | | | | | - Pouyan Pasyar
- Department of RadiologyUniversity of PennsylvaniaPhiladelphiaPAUSA
| | - Jesús Juega
- Department of NeurologyVall d’Hebron University HospitalBarcelonaSpain
| | - Zhaoyang Fan
- Departments of Radiology, Biomedical Engineering, and Radiation OncologyUniversity of Southern CaliforniaLos AngelesCAUSA
| | - Scott E. Kasner
- Department of NeurologyUniversity of PennsylvaniaPhiladelphiaPAUSA
| | | | - Jae W. Song
- Department of RadiologyUniversity of PennsylvaniaPhiladelphiaPAUSA
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Meyer S, Wilde L, Wolf F, Liman J, Bähr M, Maier IL. Doppler flow morphology characteristics of epiaortic arteries in aortic valve pathologies: a retrospective study on a cohort of patients with ischemic stroke. Ultrasound J 2023; 15:29. [PMID: 37285079 DOI: 10.1186/s13089-023-00327-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/09/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND AND AIMS Neurovascular ultrasound (nvUS) of the epiaortic arteries is an integral part of the etiologic workup in patients with ischemic stroke. Aortic valve disease shares similar vascular risk profiles and therefore not only presents a common comorbidity, but also an etiologic entity. The aim of this study is to investigate the predictive value of specific Doppler curve flow characteristics in epiaortic arteries and the presence of aortic valve disease. METHODS Retrospective, single-center analysis of ischemic stroke patients, both receiving full nvUS of the extracranial common- (CCA), internal- (ICA) and external carotid artery (ECA) and echocardiography (TTE/TEE) during their inpatient stay. A rater blinded for the TTE/TEE results investigated Doppler flow curves for the following characteristics: 'pulsus tardus et parvus' for aortic valve stenosis (AS) and 'bisferious pulse', 'diastolic reversal', 'zero diastole' and 'no dicrotic notch' for aortic valve regurgitation (AR). Predictive value of these Doppler flow characteristics was investigated using multivariate logistic regression models. RESULTS Of 1320 patients with complete examination of Doppler flow curves and TTE/TEE, 75 (5.7%) showed an AS and 482 (36.5%) showed an AR. Sixty-one (4.6%) patients at least showed a moderate-to-severe AS and 100 (7.6%) at least showed a moderate-to-severe AR. After adjustment for age, coronary artery disease, arterial hypertension, diabetes mellitus, smoking, peripheral arterial disease, renal failure and atrial fibrillation, the following flow pattern predicted aortic valve disease: 'pulsus tardus et parvus' in the CCA and ICA was highly predictive for a moderate-to-severe AS (OR 1158.5, 95% CI 364.2-3684.8, p < 0.001). 'No dicrotic notch' (OR 102.1, 95% CI 12.4-839.4, p < 0.001), a 'bisferious pulse' (OR 10.8, 95% CI 3.2-33.9, p < 0.001) and a 'diastolic reversal' (OR 15.4, 95% CI 3.2-74.6, p < 0.001) in the CCA and ICA predicted a moderate-to-severe AR. The inclusion of Doppler flow characteristics of the ECA did not increase predictive value. CONCLUSIONS Well defined, qualitative Doppler flow characteristics detectable in the CCA and ICA are highly predictive for aortic valve disease. The consideration of these flow characteristics can be useful to streamline diagnostic and therapeutic measures, especially in the outpatient setting.
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Affiliation(s)
- Stefanie Meyer
- Department of Neurology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Lara Wilde
- Department of Neurology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Frieder Wolf
- Department of Cardiology, University Medicine Göttingen, Göttingen, Germany
| | - Jan Liman
- Department of Neurology, Paracelsus Medical University Nuremberg Hospital, Nuremberg, Germany
| | - Mathias Bähr
- Department of Neurology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Ilko L Maier
- Department of Neurology, University Medicine Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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Aoki J, Suzuki K, Kanamaru T, Katano T, Sakamoto Y, Kutsuna A, Suda S, Nishiyama Y, Kimura K. Association between mitral regurgitation and clinical outcome after endovascular thrombectomy in stroke patients. Neurol Res 2020; 42:605-611. [PMID: 32497466 DOI: 10.1080/01616412.2020.1773611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Some hyperacute stroke patients have unfavorable outcomes after endovascular thrombectomy (EVT) despite successful recanalization. We hypothesized that a cardiac parameter, moderate-to-severe mitral regurgitation (MR), might decrease the rate of favorable clinical outcome after EVT in patients with atrial fibrillation (AF). METHOD From our prospective EVT registry, AF patients who underwent transthoracic echocardiography (TTE) were retrospectively analyzed. Based on the presence of moderate-to-severe MR, patients were assigned to either significant MR or nonsignificant MR group. The severity of MR was determined by the ratio of the color Doppler jet area to the left atrial area in mid-systole. Moderate-to-severe MR was estimated to be at a ratio of >20%. Favorable outcome was defined as having a modified Rankin Scale score of 0-1 at 3 months. RESULT 127 patients with AF who underwent TTE were included in the study. TTE results found that 25 (20%) patients had significant MR. Patients with significant MR were older (p = 0.051) and had enlarged left (p = 0.015) and right (p = 0.002) atria. Tricuspid and aortic regurgitation (p = 0.007 and 0.043, respectively) were more severe in significant MR group. At 3 months, favorable outcomes were 11% in the significant MR group and 26% in the non-significant MR group (p = 0.031). Multivariate regression analysis reported that moderate-to-severe MR was a negative predictor of favorable outcome (odds ratio = 0.14; 95% confidence interval = 0.02, 0.84; p = 0.031). CONCLUSIONS Significant MR might prevent the clinical recovery of AF patients.
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Affiliation(s)
- Junya Aoki
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kentaro Suzuki
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takuya Kanamaru
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takehiro Katano
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuki Sakamoto
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Akihito Kutsuna
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Satoshi Suda
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yasuhiro Nishiyama
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazumi Kimura
- Department of Neurology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Parato VM, Cardinali A, Scarano M. Aortic Regurgitation as a Risk Factor for Coronary Embolization from Complex Atheromatous Aortic Plaques: A Clinical Case. J Cardiovasc Echogr 2019; 29:58-61. [PMID: 31392120 PMCID: PMC6657464 DOI: 10.4103/jcecho.jcecho_72_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Patients with mobile aortic arch atheroma and severe aortic regurgitation may be at higher risk of systemic embolism. We report the case of a 68-year-old male patient with complex aortic arch plaque with superimposed thrombus, in which an acute inferior ST-elevation myocardial infarction occurred. In the reported case, coronary embolism may have been caused by flaked aortic plaque and/or superimposed thrombus, which was possibly carried by aortic regurgitation flow. It is a very rare mechanism by which a coronary embolism is possible from an aortic complex plaque.
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Affiliation(s)
- Vito Maurizio Parato
- Department of Emergency, Cardiology Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Alfredo Cardinali
- Department of Emergency, Cardiology Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
| | - Michele Scarano
- Department of Emergency, Cardiology Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy
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