J Thorac Cardiovasc Surg 2005;130:1483-1484
© 2005 The American Association for Thoracic Surgery
The evaluation of aortic atherosclerosis and distensibility in aortic valve stenosis—The role of transesophageal echocardiography
Attila Nemes, MD, PhD, FESC
*
,
Tamás Forster, MD, PhD, DSc, FESC,
Miklós Csanády, MD, PhD, DSc, FESC, FACC
2nd Department of Medicine and Cardiology Centre, Medical Faculty, Albert Szent-Györgyi Medical and Pharmaceutical Center, University of Szeged, Szeged, Hungary
* Address for correspondance: Attila Nemes, MD, PhD, FESC, 2nd Department of Medicine and Cardiology Centre, Albert Szent-Györgyi Medical and Pharmaceutical Centre, Medical Faculty, University of Szeged, Szeged, Hungary, H-6701 Szeged, POB 427 (Email: nemes{at}in2nd.szote.u-szeged.hu).
To the Editor:
We read with great interest and congratulate Weisenberg and associates on their transesophageal echocardiographic (TEE) study entitled "Atherosclerosis of the aorta is common in patients with severe aortic stenosis: An intraoperative transesophageal echocardiographic study."
1
This intriguing study found a strong association between the presence of severe aortic stenosis (AS) and the presence and severity of aortic atheromas, suggesting that AS might be a manifestation of the atherosclerotic process. However, we feel that a few additional comments are necessary.
Evident from previous TEE work, we demonstrated that the average grade of aortic atherosclerosis (AA) using a five-grade scale is significantly increased in AS patients with normal epicardial coronary arteries (1.44±0.64) as compared to control subjects without valvular or coronary heart disease (0.62±0.74). The degree of AA in AS patients is also similar to patients with significant left anterior descending coronary artery (LAD) disease (1.27±0.72).
2
Furthermore, another TEE study verified that, neither age, gender, high blood pressure, diabetes mellitus, hypercholesterolaemia nor coronary flow velocity reserve were suitable for the prediction of AS patients with significant LAD stenosis from AS subjects with normal epicardial coronary arteries. Only the grade of AA is suitable for the prediction of AS patients with significant LAD stenosis from AS subjects with normal epicardial coronary arteries. With respect to demographic, clinical and echocardiographic data, only the prevalence of grade 2 or 3 AA (aortic plaque) is significantly increased in AS patients with significant stenosis of the LAD.
3
Aortic distensibility can also be evaluated during TEE using aortic and blood pressure data. Different elastic properties of the descending aorta can be assessed by TEE as elastic modulus and Young's circumferential static elastic modulus. Decreased aortic distensibility (increased elastic moduli) and thus, increased stiffness of the descending aorta were demonstrated in AS patients with normal epicardial coronary arteries. This result supports that decreased aortic distensibility in AS patients is an early manifestation of the atherosclerotic process and/or decreased perfusion of the aorta.
2,5
Our initial results suggest that there are no differences in these values characterizing aortic distensibility if mitral stenosis is associated with AS.
4
Overall, these results confirm that TEE is a valuable method for the morphological (grade of aortic atherosclerosis) and functional (elastic properties of the aorta) evaluation of the descending aorta in AS patients. There is a strong relationship between the aortic atherosclerosis/distensibility and AS, suggesting that aortic valve calcification might represent an atherosclerosis-like process. However further investigations are warranted.
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References
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- Weisenberg D, Sahar Y, Sahar G, Shapira Y, Iakobishvili Z, Vidne BA, et al. Atherosclerosis of the aorta is common in patients with severe aortic stenosis. An intraoperative transesophageal echocardiographic study. J Thorac Cardiovasc Surg 2005;130:29-32.[Abstract/Free Full Text]
- Nemes A, Forster T, Csanady M. Decreased aortic distensibility and coronary flow velocity reserve in patients with significant aortic valve stenosis with normal epicardial coronary arteries. J Heart Valve Dis 2004;13:567-573.[Medline]
- Nemes A, Forster T, Thury A, Kovacs Z, Boda K, Csanady M. The comparative value of the aortic atherosclerosis and the coronary flow velocity reserve evaluated by stress transesophageal echocardiography in the prediction of patients with aortic atherosclerosis with coronary artery disease. Int J Cardiac Imag 2003;19:371-376.
- Nemes A, Forster T, Csanady M. Coronary flow velocity reserve and elastic modulus of the descending aorta in patients with aortic stenosis with or without mitral stenosis. Eur J Echocardiography Abstracts 2003;4(Suppl 1):S50.
- Nemes A, Forster T, Csanady M. Aortic distensibility in coronary artery disease and in aortic stenosis. Acta Cardiol 2005;60:55-56.[Medline]
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