The involvement of the aorta by cardiac magnetic resonance in the inflammatory process of acute coronary syndrome

Introduction

In patients presenting with acute coronary syndrome (ACS), it has been shown that multiple coronary arteries are involved during the inflammatory process. Growing literature has also revealed that carotid and aortic vessels maybe involved in the inflammatory cascade of ACS.

Purpose

To assess the involvement of the aorta during ACS by cardiac magnetic resonance (CMR).

Methods

We prospectively evaluated 78 patients who presented to the emergency department (ED) with chest pain and were classified as either: 1) ACS: if they had positive Troponin levels and typical chest pain or 2) Non-cardiac chest pain: if they had negative Troponins and a normal stress test or catheterization. We compared these 2 groups to a control group of 45 asymptomatic diabetic patients. The descending aortic wall area (AWA) and aortic wall thickness (AWT) were measured using a double inversion recovery T-2 weighted spin echo sequence by CMR with computer software analysis. See Table 1.

Table 1 Clinical and aortic wall characteristics of the study population

Results

The AWA and AWT were significantly greater in patients who presented to the ED with ACS (AWA-mean 2.28 ± 0.78 mm²; AWT-mean 3.30 ± 0.88 mm) then both patients presenting with non-cardiac CP (AWA-mean 1.52 ± 0.39 mm², p < 0.01; AWT-mean 2.53 ± 0.64 mm, p < 0.01) and the controls (AWA-mean 1.39 ± 0.36 mm², p < 0.01; AWT-mean 2.36 ± 0.80 mm, p < 0.01). There was no significant difference in the patients with non-cardiac CP compared to the controls.

Conclusion

Aortic wall may be involved in the inflammatory process of patients presenting with ACS.