Abstract T P170: Carotid Artery Intima-Media Thickness and Ankle-Brachial Index are Strong Predictors of Complicated Aortic Arch Plaque in Acute Cerebral Embolism Patients
Background: Complicated aortic arch plaque (CAP) detected by transesophageal echocardiography (TEE) provides prognostic information regarding cerebrovascular disease risk. Coexistence of peripheral atherosclerotic disease worsens the prognosis in ischemic stroke patients.
Methods: We examined TEE, carotid artery intima-media thickness (CIMT, calculated from carotid echograms), and ankle-brachial index (ABI, calculated from ankle/brachial blood pressure ratios) in 100 consecutive cerebral embolism patients within 2 weeks of onset of symptoms. CAP was defined as atherosclerotic plaque (≥4mm) or presence of ulcerated plaque assessed by TEE. Patients were classified into those with CAP (n=36, Group A) or without CAP (n=64, Group B).
Results: Comparing patients in the two groups, significantly higher values were seen in Group A for age (69±8 vs. 63±11 years, p<0.01), prevalence of hypertension (75% vs. 50%, p<0.05) and ischemic heart disease (19% vs. 3%, p<0.01), and CIMT (1.9±0.8 vs. 1.2±0.5 mm, p<0.0001). Significantly lower values were seen in Group B for ABI (0.93±0.22 vs. 1.11±0.11, p<0.0001). Defining arteriosclerosis obliterans (ASO) as ABI <0.9 and CIMT thickening as CIMT ≥1.1mm, CAP was predicted by ASO with 39% sensitivity and 97% specificity, and by CIMT thickening with 78% sensitivity and 48% specificity. Combined ASO and CIMT thickening predicted CAP with 83% sensitivity and 81% positive predictive value, and with 97% specificity and 83% negative predictive value in all of the subjects. Furthermore, aortic arch intima-media thickness was significantly correlated with CIMT and ABI (r=0.441, p<0.0001 and r=-0.384, p<0.0001, respectively).
Conclusions: For non-invasive evaluation of patients with acute cerebral embolism, the combination of both ABI and CIMT predicts CAP more strongly than either ABI or CIMT considered alone, with higher figures for sensitivity, specificity, and positive and negative predictive value.
Author Disclosures: K. Kaneko: None. H. Saito: None. Y. Tsunoda: None. S. Sugawara: None. M. Akasaka: None. T. Kanaya: None. I. Kubota: None.
- © 2015 by American Heart Association, Inc.