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Significance, Prognosis
and Treatment.
Cardiology
Meeting
Significance
Transoesophageal
echocardiography is the
investigation of choice.
– Histologic correlations of aortic
segments with TOE findings in 62
aortic segments.
Vaduganathan et al, JACC 30(2): 357-63, 1997 Aug.
Warfarin
– In the 1960s and 70s there was
concern that warfarin could worsen
the clinical picture by causing plaque
haemorrhage and increased
cholesterol embolism.
– Arko et al studied 14 patients with
Grade V atheroma and history of
embolism. All were anticoagulated.
Over 6 to 30 months, there were no
further emboli.
Arko et al Am J Surg 174:737-740, 1997.
– SPAF III trial compared standard
warfarin to low-dose warfarin +
aspirin in AF. Subgroup with aortic
plaque. Better outcomes with
standard warfarin.
Blackshear et al Am J Cardiol 83:453-5, 1999
Feb
Treatment (2)
Antiplatelet Agents
– Ferrari et al followed patients after a
diagnosis of aortic atheroma was
made on TOE.
Treatment was left up to the treating
doctor.
Patients on warfarin had fewer embolic
events and lower mortality than those on
antiplatelet agents.
Statins
– Pitsavos et al performed TOEs on 16
patients with newly diagnosed familial
hypercholesterolaemia treated with
pravastatin (baseline and 2 yrs later).
Plaque was graded. Grade was
stable in 7, progressed in 3 and
regressed in 6 patients.
Pitsavos et al Am J Cardiol 82(12): 1484-
8 1998 Dec.
Treatment (3)