관상동맥 질환 환자에서 하행 흉부대동맥 내중막 두께의 임상적 의의

배경 및 목적：경동맥 내중막 두께가 심혈관계 위험인자나 동맥경화성 질환을 가지고 있는 환자에서 심혈관계 사건의 발생과 관련이 있다고 알려져 있는데 비하여 하행 대동맥 내중막 두께의 임상적 의미는 잘 알려져 있지 않다.방 법：관상동맥조영술로 증명된 관상동맥경화 환자 104명에서 경식도 심초음파를 시행하여 하행 대동맥 내중막 두께를 측정하였고 공통 경동맥 초음파를 이용하여 경동맥 내중막 두께를 측정한 후 평균 50개월간 임상경과를 추적하였다. 결 과： 하행대동맥 내중막 두께가 두꺼운 군(n=44, >0.21 mm)에서 얇은 군(n=60, ≤0.21 mm)에 비하여 뇌졸중(6.7% vs. 2.8%, p=0.04), 말초혈관질환(6.7% vs. 1.9%, p=0.02), 과 사망(2.9% vs. 0%, p=0.04)이 의미있게 더 발생하였다. 한편 경동맥 내중막 두께에 두꺼운 군(n=49, >0.089 mm)에서는 얇은 군(n=55, ≤0.089 mm)에 비하여 말초혈관질환만 더 발생하였다(16% vs 2%, p=0.009). 결 론： 하행 대동맥 내중막 두께는 관상동맥경화환자에서 뇌졸중, 말초혈관질환 및 사망률과 관련이 있으며 이며 하행 대동맥 내중막 두께가 경동맥 내중막 두께보다 관상동맥 경화환자의 예후에 더욱 밀접한 관련이 있음을 시사해준다. Background and Objectives：While the clinical significance of descending thoracic aorta intima-media thickness (DTA-IMT) remains unclear, common carotid IMT (CIMT) is known to be associated with major adverse cardiovascular events (MACE) in patients with atherosclerotic disease. Subjects and Methods：A total of 104 patients (mean age, 59 yrs; 69 male) with angiographically proven coronary atherosclerosis underwent transesophageal echocardiography (TEE) for DTA-IMT measurement and carotid scanning for CIMT measurement. The patients were divided into two groups based on the median IMT value, and they were followed up for cardiovascular events and all-cause mortality for a period of 50±21 months. Results：Patients having a higher DTA-IMT value (n=44, >2.1 mm) had a higher chance of stroke (6.7% vs. 2.8%, p=0.04), peripheral vascular disease (6.7% vs. 1.9%, p=0.02), and death (2.9% vs. 0%, p=0.04) than those who had lower DTA-IMT values (n=60, ≤2.1 mm). The patients who had higher CIMT values (n=49, >0.089 mm) had a higher chance of peripheral vascular disease (16% vs 2%, p=0.009) than those having lower IMT values (n=55, ≤0.089 mm). However, there was no significant difference between the groups in terms of recurrent chest pain, heart failure, syncope, myocardial infarction or chronic kidney disease during the follow-up period. Multivariate Cox regression analysis revealed that increased DTA-IMT was associated with stroke (OR, 4.29; 95% CI, 1.076-17.181; p=0.039) and peripheral vascular disease (OR, 9.37; 95% CI, 1.571-55.499; p=0.014), whereas increased CIMT was associated with peripheral vascular disease (OR, 14.365; 95% CI, 1.050-196.540; p=0.046). Conclusion：This study suggests that descending thoracic aorta IMT is more closely associated with prognosis in patients with coronary atherosclerosis than CIMT. (Korean Circulati