Impact of aortic atheroma and distensibility on diastolic function and prognosis in patients with ischemic stroke

• Published in: Reviews in cardiovascular medicine Vol. 23; no. 1; p. 10
• Main Authors: Kim, Dae-Young, Kim, In-Soo, Jung, Yo Han, Lee, Kyung Yul, Kim, Jong-Youn, Min, Pil-Ki, Yoon, Young Won, Lee, Byoung Kwon, Hong, Bum-Kee, Rim, Se-Joong, Kwon, Hyuck Moon, Choi, Eui-Young
• Format: Journal Article
• Language: English
• Published: Singapore IMR Press 11.01.2022
• Subjects: Aorta - diagnostic imaging; aortic atheroma; diastolic function; Female; Heart Failure - complications; Heart Failure - diagnostic imaging; Humans; Ischemic Stroke; Male; Plaque, Atherosclerotic - complications; Prognosis; Stroke Volume; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - etiology; Ventricular Function, Left; Diastolic function; Prognosis; Ischemic stroke; Aortic atheroma
• ISSN: 1530-6550
• DOI: 10.31083/j.rcm2301010

Patients with ischemic stroke are vulnerable to heart failure with preserved ejection fraction (HFpEF) because these conditions share common risk factors. Although evaluation of the ascending aorta, aortic arch, and proximal descending thoracic aorta is an essential step to determine the source of the causative embolism, the relationship between the degree of aortic atheroma and left ventricular (LV) diastolic function has not been extensively investigated. We analyzed the transesophageal and transthoracic echocardiography in ischemic stroke patients. Patients with previous coronary artery disease, valvular heart disease of more than moderate degree, and an LV ejection fraction of less than 50% were excluded. The relationships between the grade of the aortic atheroma, aortic stiffness indexes, and diastolic functional indexes were evaluated. In 295 patients, the atheroma grade was significantly correlated with aortic stiffness index, ratio of mitral annular and inflow velocities (E/e'), left atrial volume index, and LV diastolic elastance. With further adjustment for age, hypertension, diabetes, estimated glomerular filtration rate, left atrial volume index, and LV mass index, the significance of the atheroma grade was attenuated. In the subgroup analysis, the atheroma grade was significantly and independently related to E/e' in women (β = 0.181, = 0.032), but not in men. However, atheroma grade was not associated with poor clinical outcomes in either sex. Aortic atheroma grade was significantly and independently related to LV diastolic function, especially in women. This suggests that aortic atheroma is an index of arterial stiffness and a potential risk factor for HFpEF through ventricular-vascular interactions, especially in women.