Journal of the American Society of Echocardiography
Volume 23, Issue 7 , Pages 772-777, July 2010

Association between Carotid Intima-Media Thickness and Aortic Arch Plaques

  • Elena Tessitore, MD

      Affiliations

    • Department of Medicine, Columbia University, New York, New York
    • ,
  • Tatjana Rundek, MD

      Affiliations

    • Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida
    • ,
  • Zhezhen Jin, PhD

      Affiliations

    • Department of Biostatistics, Columbia University, New York, New York
    • ,
  • Shunichi Homma, MD

      Affiliations

    • Department of Medicine, Columbia University, New York, New York
    • ,
  • Ralph L. Sacco, MD

      Affiliations

    • Department of Neurology, Miller School of Medicine, University of Miami, Miami, Florida
    • Department of Epidemiology and Human Genetics, Miller School of Medicine, University of Miami, Miami, Florida
    • ,
  • Marco R. Di Tullio, MD

      Affiliations

    • Department of Medicine, Columbia University, New York, New York
    • Corresponding Author InformationReprint requests: Marco R. Di Tullio, MD, Columbia University, 622 W 168th Street, PH 3-342, New York, NY 10032.

published online 31 May 2010.

Background

Large aortic arch plaques are associated with ischemic stroke. Carotid intima-media thickness (CIMT) is a marker of subclinical atherosclerosis and a strong predictor of cardiovascular disease and stroke. The association between CIMT and aortic arch plaques has been studied in patients with strokes, but not in the general population. The aim of this study was to investigate this association in an elderly asymptomatic cohort and to assess the possibility of using CIMT to predict the presence or absence of large aortic arch plaques.

Methods

Stroke-free control subjects from the Aortic Plaque and Risk of Ischemic Stroke (APRIS) study underwent transesophageal echocardiography and high-resolution B-mode ultrasound of the carotid arteries. CIMT was measured at the common carotid artery, bifurcation, and internal carotid artery. The association between CIMT and aortic arch plaques was analyzed using multivariate regression models. The positive and negative predictive values of CIMT for large (≥4 mm) aortic arch plaques were calculated.

Results

Among 138 subjects, large aortic arch plaques were present in 35 (25.4%). Only CIMT at the bifurcation was associated with large aortic arch plaques after adjustment for atherosclerotic risk factors (P = .007). The positive and negative predictive values of CIMT for aortic arch plaque ≥ 4 mm at the bifurcation above the 75th percentile (≥0.95 mm) were 42% and 80%, respectively. The negative predictive value increased to 87% when the median CIMT value (0.82 mm) was used.

Conclusions

CIMT at the bifurcation is independently associated with aortic arch plaque ≥ 4 mm. Its strong negative predictive value for large plaques indicates that CIMT may be used as an initial screening test to exclude severe arch atherosclerosis in the general population.

Keywords: Atherosclerosis, Carotid artery, Intima-media thickness, Aorta, Transesophageal echocardiography

Abbreviations: APRIS, Aortic Plaque and Risk of Ischemic Stroke, BIF, Bifurcation, CCA, Common carotid artery, CIMT, Carotid intima-media thickness, IMT, Intima-media thickness, NOMAS, Northern Manhattan Stroke Study, TEE, Transesophageal echocardiography

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 This study was supported by grant R01 NS36286 from the National Institute of Neurological Disorders and Stroke (Bethesda, MD). Dr Di Tullio was the recipient of Mid-Career Award in Patient-Oriented Research K24 NS02241 from the National Institute of Neurological Disorders and Stroke.

PII: S0894-7317(10)00332-9

doi:10.1016/j.echo.2010.04.012

Journal of the American Society of Echocardiography
Volume 23, Issue 7 , Pages 772-777, July 2010

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