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Aortic Valve Sclerosis as an Important Predictor of Long-Term Mortality in Patients With Carotid Atheromatous Plaque Requiring Carotid Endarterectomy

Background: A strong association between aortic valve sclerosis (AVSc), the earliest manifestation of calcific aortic valve disease, and atherosclerosis exists. The aim of the study was to evaluate the predictive capabilities of AVSc on long-term all-cause mortality, in patients requiring carotid en...

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Autores principales: Myasoedova, Veronika A., Saccu, Claudio, Chiesa, Mattia, Songia, Paola, Alfieri, Valentina, Massaiu, Ilaria, Valerio, Vincenza, Moschetta, Donato, Gripari, Paola, Naliato, Moreno, Cavallotti, Laura, Spirito, Rita, Trabattoni, Piero, Poggio, Paolo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193358/
https://www.ncbi.nlm.nih.gov/pubmed/34124193
http://dx.doi.org/10.3389/fcvm.2021.653991
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author Myasoedova, Veronika A.
Saccu, Claudio
Chiesa, Mattia
Songia, Paola
Alfieri, Valentina
Massaiu, Ilaria
Valerio, Vincenza
Moschetta, Donato
Gripari, Paola
Naliato, Moreno
Cavallotti, Laura
Spirito, Rita
Trabattoni, Piero
Poggio, Paolo
author_facet Myasoedova, Veronika A.
Saccu, Claudio
Chiesa, Mattia
Songia, Paola
Alfieri, Valentina
Massaiu, Ilaria
Valerio, Vincenza
Moschetta, Donato
Gripari, Paola
Naliato, Moreno
Cavallotti, Laura
Spirito, Rita
Trabattoni, Piero
Poggio, Paolo
author_sort Myasoedova, Veronika A.
collection PubMed
description Background: A strong association between aortic valve sclerosis (AVSc), the earliest manifestation of calcific aortic valve disease, and atherosclerosis exists. The aim of the study was to evaluate the predictive capabilities of AVSc on long-term all-cause mortality, in patients requiring carotid endarterectomy (CEA). Methods and Results: 806 consecutive CEA patients were enrolled. Preoperative echocardiography was used to assess AVSc. Computed tomography angiography was applied for plaque characterization. Kaplan-Meier curves, Cox linear regression, and area under the receiving operator characteristic (AUC) curve analyses were used to evaluate the predictive capability of AVSc. Overall, 348 of 541 patients had AVSc (64%). Age, diabetes, and estimated glomerular filtration rate (eGFR) were associated with AVSc. In the 5-year follow-up, AVSc group had a mortality rate of 16.7% while in no-AVSc group was 7.8%. Independent predictors of all-cause mortality were age, sex, eGFR, left ventricular ejection fraction, and AVSc. After adjustments, AVSc was associated with a significant increase in all-cause mortality risk (hazard ratio, HR = 1.9; 95%CI: 1.04–3.54; p = 0.038). We stratify our cohort based on carotid atheromatous plaque-type: soft, calcified, and mixed-fibrotic. In patients with mixed-fibrotic plaques, the mortality rate of AVSc patients was 15.5% compared to 2.4% in no-AVSc patients. In this group, AVSc was associated with an increased long-term all-cause mortality risk with an adjusted HR of 12.8 (95%CI: 1.71–96.35; p = 0.013), and the AUC, combing eGFR and AVSc was 0.77 (p < 0.001). Conclusions: Our findings indicate that AVSc together with eGFR may be used to improve long-term risk stratification of patients undergoing CEA surgery.
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spelling pubmed-81933582021-06-12 Aortic Valve Sclerosis as an Important Predictor of Long-Term Mortality in Patients With Carotid Atheromatous Plaque Requiring Carotid Endarterectomy Myasoedova, Veronika A. Saccu, Claudio Chiesa, Mattia Songia, Paola Alfieri, Valentina Massaiu, Ilaria Valerio, Vincenza Moschetta, Donato Gripari, Paola Naliato, Moreno Cavallotti, Laura Spirito, Rita Trabattoni, Piero Poggio, Paolo Front Cardiovasc Med Cardiovascular Medicine Background: A strong association between aortic valve sclerosis (AVSc), the earliest manifestation of calcific aortic valve disease, and atherosclerosis exists. The aim of the study was to evaluate the predictive capabilities of AVSc on long-term all-cause mortality, in patients requiring carotid endarterectomy (CEA). Methods and Results: 806 consecutive CEA patients were enrolled. Preoperative echocardiography was used to assess AVSc. Computed tomography angiography was applied for plaque characterization. Kaplan-Meier curves, Cox linear regression, and area under the receiving operator characteristic (AUC) curve analyses were used to evaluate the predictive capability of AVSc. Overall, 348 of 541 patients had AVSc (64%). Age, diabetes, and estimated glomerular filtration rate (eGFR) were associated with AVSc. In the 5-year follow-up, AVSc group had a mortality rate of 16.7% while in no-AVSc group was 7.8%. Independent predictors of all-cause mortality were age, sex, eGFR, left ventricular ejection fraction, and AVSc. After adjustments, AVSc was associated with a significant increase in all-cause mortality risk (hazard ratio, HR = 1.9; 95%CI: 1.04–3.54; p = 0.038). We stratify our cohort based on carotid atheromatous plaque-type: soft, calcified, and mixed-fibrotic. In patients with mixed-fibrotic plaques, the mortality rate of AVSc patients was 15.5% compared to 2.4% in no-AVSc patients. In this group, AVSc was associated with an increased long-term all-cause mortality risk with an adjusted HR of 12.8 (95%CI: 1.71–96.35; p = 0.013), and the AUC, combing eGFR and AVSc was 0.77 (p < 0.001). Conclusions: Our findings indicate that AVSc together with eGFR may be used to improve long-term risk stratification of patients undergoing CEA surgery. Frontiers Media S.A. 2021-05-28 /pmc/articles/PMC8193358/ /pubmed/34124193 http://dx.doi.org/10.3389/fcvm.2021.653991 Text en Copyright © 2021 Myasoedova, Saccu, Chiesa, Songia, Alfieri, Massaiu, Valerio, Moschetta, Gripari, Naliato, Cavallotti, Spirito, Trabattoni and Poggio. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Myasoedova, Veronika A.
Saccu, Claudio
Chiesa, Mattia
Songia, Paola
Alfieri, Valentina
Massaiu, Ilaria
Valerio, Vincenza
Moschetta, Donato
Gripari, Paola
Naliato, Moreno
Cavallotti, Laura
Spirito, Rita
Trabattoni, Piero
Poggio, Paolo
Aortic Valve Sclerosis as an Important Predictor of Long-Term Mortality in Patients With Carotid Atheromatous Plaque Requiring Carotid Endarterectomy
title Aortic Valve Sclerosis as an Important Predictor of Long-Term Mortality in Patients With Carotid Atheromatous Plaque Requiring Carotid Endarterectomy
title_full Aortic Valve Sclerosis as an Important Predictor of Long-Term Mortality in Patients With Carotid Atheromatous Plaque Requiring Carotid Endarterectomy
title_fullStr Aortic Valve Sclerosis as an Important Predictor of Long-Term Mortality in Patients With Carotid Atheromatous Plaque Requiring Carotid Endarterectomy
title_full_unstemmed Aortic Valve Sclerosis as an Important Predictor of Long-Term Mortality in Patients With Carotid Atheromatous Plaque Requiring Carotid Endarterectomy
title_short Aortic Valve Sclerosis as an Important Predictor of Long-Term Mortality in Patients With Carotid Atheromatous Plaque Requiring Carotid Endarterectomy
title_sort aortic valve sclerosis as an important predictor of long-term mortality in patients with carotid atheromatous plaque requiring carotid endarterectomy
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193358/
https://www.ncbi.nlm.nih.gov/pubmed/34124193
http://dx.doi.org/10.3389/fcvm.2021.653991
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