Vascular events during follow-up in patients with aortic arch atherosclerosis.

BACKGROUND AND PURPOSE: An association between aortic arch atherosclerosis and vascular events has been demonstrated. However, few data exist regarding follow-up evaluation of this disease. METHODS: In this study, 183 patients with the diagnosis of aortic arch atherosclerosis were prospectively followed up. This diagnosis was made during an echocardiographic cross-sectional study. In 136 patients, raised plaques with thickness < 5 mm had been shown to exist, and in 47 patients complex plaques with thickness > or = 5 mm or plaques with mobile components had been demonstrated on the initial transesophageal echocardiography. RESULTS: During a mean follow-up period of 16 +/- 7 months, vascular events with a presumed embolic origin occurred in 15 patients. The incidence was 4.1 per 100 person-years in patients with raised plaques compared with 13.7 per 100 person-years in the group with complex plaques. The Kaplan-Meier survival analysis revealed a significantly higher rate of vascular events in patients who were found to have complex plaques (P < .01). In the Cox proportional hazards analysis, the finding of complex plaques (relative risk [RR], 4.3; 95% confidence interval [CI], 1.5 to 12.0; P = .006), coronary artery disease (RR, 4.0; 95% CI, 1.2 to 13.1; P = .02), and a history of previous embolism (RR, 4.0; 95% CI, 1.1 to 14.4; P = .03) were independent predictors of vascular events. CONCLUSIONS: Patients with the finding of protruding plaques or plaques with mobile components have a high risk of subsequent vascular events.

[Determinants of arterial embolism with special reference to atheromatous changes of the thoracic aorta]. / Determinanten arterieller Embolien unter besonderer Berücksichtigung atheromatöster Veränderungen der thorakalen Aorta.

Potential sources of arterial embolism were evaluated with special emphasis on aortic atheromatosis in patients who underwent transesophageal echocardiography for various clinical reasons. Among 375 patients, 166 had suffered from cerebrovascular disease or peripheral embolism and 209 were free from symptoms of embolism. Univariate analysis revealed that atheromatosis of the aortic arch and descending aorta as well as cardiac thrombi, aneurysms of the interatrial septum and arterial hypertension were significantly more common in patients who had a history of embolism or ischemic stroke. In a stepwise multiple regression analysis, aortic arch atheromatosis (odds ratio 1.7, 95% CI 1.1-2.6), cardiac thrombi (odds ratio 4.1, 95% CI 1.7-9.8), atrial septal aneurysm (odds ratio 3.0, 95% CI 1.2-7.8) and arterial hypertension (odds ratio 1.8, 95% CI 1.1-3.0) were determined as independent predictors of embolic symptoms. We conclude that atheromatous lesions of the aortic arch are an independent risk factor for arterial embolism and ischemic stroke among other well known sources of embolism.

Systemic embolism in aortic arch atheromatosis.

The role of aortic atheromatosis as a risk factor for systemic embolism and its relationship to other potential sources of embolism was examined in 335 patients undergoing transoesophageal echocardiography for various clinical reasons. Multiple logistic regression analysis revealed a significant correlation between embolism and moderate (atheroma protruding less than 5 mm into the aortic lumen, grade 2) to complex (atheroma protruding at least 5 mm into the vessel lumen with or without mobile components, grade 3) atherosclerosis of the aortic arch. Odds ratios were 4.0 for grade 2 atheromatosis (95% CI 1.1-14.4; P < 0.05) and 9.7 for grade 3 atheromatosis (95% CI 1.5-61.0; P < 0.05). Other significant associations were found with cardiac thrombi (odds ratio 4.0, 95% CI 1.7-9.3; P < 0.005) and hypertension (odds ratio 1.8, 95% CI 1.0-3.3; P < 0.05). In a subset of 163 patients in whom results of an ultrasound examination were available, atherosclerosis of the carotid arteries was another significant marker of embolism (odds ratio 2.0, 95% CI 1.2-3.3; P < 0.01). In conclusion, aortic arch atheromatosis, which was predominantly recognized in patients with cerebrovascular events of undetermined cause, seems to carry a risk of embolism that is comparable to cardiac and carotid atherosclerosis.

The mouse Enhancer trap locus 1 (Etl-1): a novel mammalian gene related to Drosophila and yeast transcriptional regulator genes.

A novel mouse gene, Enhancer trap locus 1 (Etl-1), was identified in close proximity to a lacZ enhancer trap integration in the mouse genome showing a specific beta-galactosidase staining pattern during development. In situ analysis revealed a widespread but not ubiquitous expression of Etl-1 throughout development with particularly high levels in the central nervous system and epithelial cells. The amino acid sequence of the Etl-1 protein deduced from the cDNA shows strong similarity, over a stretch of 500 amino acids, to the Drosophila brahma protein involved in the regulation of homeotic genes and to the yeast transcriptional activator protein SNF2/SWI2 as well as to the RAD54 protein and the recently described helicase-related yeast proteins STH1 and MOT1. Etl-1 is the first mammalian member of this group of proteins that are implicated in gene regulation and/or influencing chromatin structure. The homology to the regulatory proteins SNF2/SWI2 and brahma and the expression pattern during embryogenesis suggest that Etl-1 protein might be involved in gene regulating pathways during mouse development.