SPONTANEOUS ECHOCARDIOGRAPHIC CONTRAST IN THE THORACIC AORTA - FACTORS ASSOCIATED WITH ITS OCCURRENCE AND ITS ASSOCIATION WITH EMBOLIC EVENTS

Spontaneous echocardiographic contrast is associated with embolic even ts when it occurs in the left atrium. Because little is known about sp ontaneous echocardiographic contrast in the aorta, we investigated thi s association retrospectively in 343 patients without aortic dissectio n or aneurysm who had undergone transesophageal echocardiography. Two independent readers concurred on the presence of spontaneous echocardi ographic contrast in the aorta in 93% of the study patients, with the remainder agreed on by consensus. Spontaneous echocardiographic contra st was found in 65 patients (19%) and was associated with older age (p < 0.0001), male sex (p < 0.0001), slightly larger aortas (p < 0.0001) , and complex aortic atherosclerosis (p = 0.0001). Thirty-four (28.6%) of 119 patients with clinical embolic events had spontaneous echocard iographic contrast in the aorta in contrast to 31 (13.8%) of 224 patie nts referred for other reasons (p = 0.0001). This finding remained sig nificant when spontaneous echocardiographic contrast in the aorta was the only abnormality allowed (n = 207, p = 0.0065) or when other echoc ardiographic variables known to be related to embolic events were incl uded in a multivariate analysis. Thus, spontaneous echocardiographic c ontrast in the aorta can often be detected by transesophageal echocard iography and is associated with a higher prevalence of embolic events.