Association between asymptomatic carotid atherosclerosis and degenerative aortic stenosis

Novo, Giuseppina; Guarneri, Francesca; Ferro, G; Russo, R; Fattouch, Khalil; Novo, Salvatore

doi:10.1016/j.atherosclerosis.2012.06.011

Cited by 16 publications

(15 citation statements)

References 20 publications

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“…29 However, the present study is a prospective cohort study, which is free of many of the biases inherent to case series and case-control studies and our study, therefore, strengthen previous evidence. 30 Collectively, our study and the previous case-control study provide evidence for a role of the processes underlying high carotid IMT and atherosclerotic plaque in the pathophysiology of AS.…”

Section: Discussionsupporting

confidence: 77%

Carotid Plaque, Intima-Media Thickness, and Incident Aortic Stenosis

Martinsson

Östling

Persson

et al. 2014

ATVB

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Objective-Aortic stenosis (AS) shares risk factors with atherosclerotic vascular disease. Carotid intima-media thickness (IMT) and plaque may reflect the cumulative damage from exposure to different atherosclerotic risk factors. We examined the relationship of carotid IMT and plaque with incident AS in a prospective population-based study. Approach and Results-A random sample of participants (age, 45-68 years) in the population-based Malmö Diet and Cancer Study underwent B-mode ultrasound with measurements of IMT and the presence of plaque in the common carotid artery (n=5079). Potential risk factors for incident AS were studied in age-and sex-adjusted and expanded multivariable-adjusted Cox regression models. A total of 69 (1.4%) participants developed AS during up to 20 years of follow-up. Significant risk factors for AS in age-and sex-adjusted analyses were (P<0.05) body mass index, low-density lipoprotein cholesterol, hypertension, diabetes mellitus, smoking, C-reactive protein, plaque, and IMT. In contrast, highdensity lipoprotein cholesterol, triglycerides, height, and leukocyte count were not significantly associated with AS (P>0.05). After adjustments, IMT, plaque, age, smoking, C-reactive protein, low-density lipoprotein cholesterol, and diabetes mellitus remained significantly associated with incident AS. IMT was no longer significantly associated with AS after adjustments for plaque and systolic blood pressure, but plaque remained significantly associated with incident AS. ultrasound and is often a manifestation of atherosclerosis. 16,17 IMT is a risk marker for stroke and acute myocardial infarction but results are conflicting as to the added value of IMT to other established risk factors. [18][19][20][21][22][23][24][25] It has been postulated that common carotid artery IMT might also be a surrogate marker of coronary artery disease. 26 An association between IMT and aortic valve sclerosis has been established previously, 27 but it remains unclear whether the association applies to incident AS. Conclusions-TraditionalOur aim was to test the association of conventional cardiovascular risk factors, carotid IMT measures, and the presence of carotid plaque with incident AS. To our knowledge, no prospective population-based studies have examined the relationship between vascular ultrasound measurements and AS. Materials and MethodsMaterial and Methods are available in the online-only Supplement. Results Baseline CharacteristicsDuring a follow-up time of up to 20 years (mean, 16.5 years), 69 (1.4%) of the 5079 participants in the IMT samples were diagnosed with incident AS. The baseline characteristics across quartiles of IMT are shown in Table 1 Age-and Sex-Adjusted AnalysesWe observed a significant association between IMT in the common carotid artery and incident AS (hazard ratio [HR], 1.46 per 1-SD increment; P<0.01) as shown in Table 2. BMI, lowdensity lipoprotein cholesterol, CRP, diabetes mellitus, smoking, and hypertension were also associated with incident AS (P<0.05). In contrast, no significa...

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Section: Discussionsupporting

confidence: 77%

Carotid Plaque, Intima-Media Thickness, and Incident Aortic Stenosis

Martinsson

Östling

Persson

et al. 2014

ATVB

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“…In patients with AS of any degree of severity, CA (defined as any carotid plaque) was evident in 70% of 135 participants (vs. 42% in controls with a normal aortic valve, P < 0.0001), although the severity of the carotid stenoses and their distribution (unilateral vs. bilateral) were not reported in this study [16]. Studies conducted in the surgical setting have provided inconsistent results.…”

Section: Previous Studies Of Carotid Disease In As Patientscontrasting

confidence: 61%

“…Although this observation is likely to be explained, at least in part, by the advanced age and preponderance of vascular disease in our TAVI patients, it is possible that this also reflects a direct association between AS and CAS [16,20].…”

Section: Cas In Tavi Patientsmentioning

confidence: 75%

“…A number of studies, in settings other than TAVI, have recently examined the prevalence of asymptomatic CAS in patients with aortic valve stenosis of varying severity [6,9,10,16]. In patients with AS of any degree of severity, CA (defined as any carotid plaque) was evident in 70% of 135 participants (vs. 42% in controls with a normal aortic valve, P < 0.0001), although the severity of the carotid stenoses and their distribution (unilateral vs. bilateral) were not reported in this study [16].…”

Section: Previous Studies Of Carotid Disease In As Patientsmentioning

confidence: 99%

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Prevalence and predictors of carotid artery stenosis in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation

Steinvil

Leshem

Abramowitz

et al. 2014

Cathet Cardio Intervent

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“…The etiology of strokes in TAVI appears to be multifactorial, but intraoperative embolic events, periprocedural hypotension, and prior history of cerebrovascular disease[819] have been reported to play dominant roles. [7] Several transcranial Doppler (TCD) studies have visualized embolic phenomena during manipulation of catheters across the aortic valve and during valve implantation.…”

Section: Discussionmentioning

confidence: 99%

Carotid artery disease and periprocedural stroke risk after transcatheter aortic valve implantation

Muluk¹,

Udesh

Mehta

et al. 2017

Ann Card Anaesth

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Objective/Background:To examine the role of carotid stenosis (CS) and other independent risk factors of perioperative stroke, following transcatheter aortic valve implantation (TAVI).Materials and Methods:Using data from the National Inpatient Sample database for analysis, patients who underwent TAVI were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification codes. Various preoperative and perioperative risk factors and their association with perioperative strokes were studied.Results:Data on 7566 patients who underwent a TAVI procedure from 2012 to 2013 were extracted. The average age of the patient population was 81.2 ± 0.32 years. The overall perioperative stroke rate in our patient cohort was 2.79%. Majority (94.6%) of the strokes were ischemic. Multivariate analysis showed the following independent risk factors for perioperative strokes after TAVI: female gender odds ratio (OR) = 2.25 (95% confidence interval [CI], 1.42–3.57), higher van Walraven score OR = 6.6 (95% CI = 3.71–11.73), bilateral CS OR = 4.46 (95% CI = 2.03–9.82), and TAVI with a cardiac procedure done under cardiopulmonary bypass OR = 2.84 (95% CI = 1.57–5.14).Conclusion:Bilateral carotid disease is a significant risk factor for perioperative strokes following TAVI. Preoperative screening with carotid Doppler to identify high-risk patients appears to be warranted. In addition, patients of female gender were found to have an increased risk for carotid disease.

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Association between asymptomatic carotid atherosclerosis and degenerative aortic stenosis

Cited by 16 publications

References 20 publications

Carotid Plaque, Intima-Media Thickness, and Incident Aortic Stenosis

Carotid Plaque, Intima-Media Thickness, and Incident Aortic Stenosis

Prevalence and predictors of carotid artery stenosis in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation

Carotid artery disease and periprocedural stroke risk after transcatheter aortic valve implantation

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