Natural History and Risk Factors of Aortic Atheroma in Stroke Patients: Impact of Aortic Stiffness and Sex Differences

Abstract Aortic atheroma (AA) is an independent risk factor for stroke and may gradually progress, but data on its development are limited. We enrolled 131 stroke patients (mean age 62 ± 10 years, 92 males) undergoing serial transesophageal echocardiography (TEE). AA was graded based on plaque thickness and complexity; progression was defined as an increase in maximum plaque thickness by one grade or more. Aortic stiffness was assessed through pulse wave analysis and global circumferential aorta strain (GCAS) using 2D speckle tracking. The aortic stiffness index (β) was also calculated. Over a median follow-up of 23.6 [20.8–26.8] months, AA progressed in 13 (9.9%), regressed in 14 (10.7%), and remained unchanged in 104 (79.4%). Female patients showed more progression (p < 0.01), while LDL cholesterol levels, statin dose, and baseline plaque thickness were not significantly linked. GCAS and β were significantly associated (p < 0.001 for GCAS; p = 0.041 for β) with AA changes. After adjusting for clinical variables, female gender, GCAS, and β remained significantly related to AA progression (OR 9.06, 95% CI 2.13–50.76, p = 0.005; OR 0.35, 95% CI 00.17–0.62, p < 0.001; OR 1.09, 95% CI 1.02–1.19, p = 0.021, respectively). AA exhibits dynamic changes over two years in stroke patients. Female gender and aortic stiffness are significantly associated with AA progression, suggesting that aortic stiffness may influence the course of aortic atherosclerosis.