DISRUPTED MOBILE AORTIC PLAQUES ARE A MAJOR RISK FACTOR FOR SYSTEMIC EMBOLISM IN THE ELDERLY

Protruding aortic plaques - especially those with mobile properties - on transesophageal echocardiography (TEE) are a potential source of st roke and systemic embolism in the elderly. Whether the various morphol ogies of atheromas with mobile components represent potential differen ces in the risk for embolic events has not been thoroughly elucidated. The goal of the present study was to determine the association betwee n embolic events and the various types of mobile lesions in the thorac ic aorta. Our population consisted of 569 consecutive patients (age 18 -83 years) referred for TEE over 27 months; 108 (19%) of them were ref erred to evaluate recent embolism (cerebral in 97 and peripheral or bo th in 11; group I) and the remaining 461 were admitted for reasons unr elated to embolism (group II). In group I, 35 patients (32%) exhibited protruding plaques those were fixed in 10 (9%) and with a mobile comp onent in 25 (23%), In group II, plaques were found in only 13 patients (3%); fixed in 9 (2%) and mobile in 4 (1%), Twenty-four patients with mobile lesions in group I were > 50 years old, and 21 of them (88%) w ere > 60 years old, While the presence of fixed plaques was associated with a moderate increase in the risk for systemic embolism (adjusted odds ratio 30.1; 95% confidence interval 1.3-56.4), mobile lesions wer e linked to a striking augmentation of this risk (odds ratio 30.1; 95% confidence interval 7,8-132.6), The majority of mobile lesions (76%) in group I represented disrupted atheromas with charateristic ulcerati ons or echolucency within the plaque suggestive of intraatheroma hemor rhage, whereas these TEE features were not observed in 89% of the mobi le lesions in group II (p = 0.0003), We conclude that among the variou s types of mobile aortic lesions, the disrupted protruding plaques are a major risk factor for stroke and embolic events in the elderly.