Aortic plaque in atrial fibrillation - Prevalence, predictors, and thromboembolic implications

Background ann Purpose-Thoracic aortic plaque identified by transesophageal echocardiography heightens the risk of stroke associated with atrial fibri llation (AF). We sought to identify the prevalence, predictors, and implica tions of aortic plaque in patients with nonvalvular AF. Methods-Thoracic aortic plaque was prospectively sought in 770 persons with AF with the use of transesophageal echocardiography and classified as simp le or complex on the basis of thickness greater than or equal to 4 mm, ulce ration, or mobility. Clinical and echocardiographic features of thromboembo lism were correlated by multivariate analysis. Results-Aortic plaque was detected in 57% of the cohort, and complex plaque was detected in 25%. Both were found more frequently in the descending tha n in the proximal aorta. Potentially etiologic patient characteristics inde pendently associated with complex plaque included advanced age, history of hypertension, diabetes, and past or present tobacco use. Comorbidities asso ciated with aortic plaque were prior thromboembolism, increased pulse press ure, ischemic heart disease, stenosis or sclerosis of the aortic valve, mit ral annular calcification (>10%), elevated serum creatinine concentration, spontaneous echo contrast in the left atrium or appendage, and left atrial appendage thrombus. The prevalence of complex plaque in patients aged <70 y ears with <10% mitral annular calcification, without ischemic heart disease , or without pulse pressure greater than or equal to 65 mm Hg was 4% (95% C I, 1% to 6%). Conclusions-Aortic plaque is prevalent in patients with AF and is associate d with atherosclerosis risk factors and with left atrial stasis or thrombos is, which an themselves independent stroke risk factors. Since the predomin ant location of complex plaque was in the descending aorta, the role of aor tic plaque as a source of embolism in AF is uncertain.