Comparison of echocardiographic markers of embolism in atrial flutter and fibrillation: Frequency of protruding atherosclerotic plaques in the thoracic aorta

The potential additional embolic risk of protruding aortic plaques greater than or equal to 4 mm and left atrial abnormalities such as thrombus, spont aneous echocardiographic contrast (SEC), low left atrial appendage velocity , recently has been, shown in patients with atrial fibrillation (AF). Howev er, the presence and potential role of transesophageal echocardiographic (T EE)-detected protruding aortic plaques greater than or equal to 4 mm have n ot been systematically evaluated in patients with atrial flutter. Among 249 3 patients evaluated by TEE, 271 consecutive patients with atrial flutter ( n = 41) and AF (n = 230) greater than or equal to 2 days duration were incl uded in the study. Clinical and echocardiographic characteristics in consec utive patients with atrial flutter were compared to those in patients with AF, especially atrial morphology and function and atherosclerotic disease o f the thoracic aorta. Clinical characteristics of patients with atrial flut ter and AF were similar with regard to age (68 +/- 13 and 67 +/- 12 P = 0.6 28), sex ratio (men, 66% and 54%, P = 0.212), and previous embolic events ( 5% and 15%, P = 0.126), respectively. The frequency of protruding atheroscl erotic plaques greater than or equal to 4 mm (12% and 11%), P = 0.919) and SEC (15% and 14%, P = 0.847) in the thoracic aorta was similar in patients with atrial flutter and AF. Left atrial appendage area was smaller (3.1 +/- 0.7 and 6.0 +/- 3.0 cm(2), P = 0.001), left atrial appendage SEC was less frequent (17% and 37%, P = 0.024), and left atrial appendage emptying veloc ity was higher (47 +/- 10 and 30 +/- 10 cm/s, P = 0.030) in patients with a trial flutter as compared to those with AF. There was no difference between the two groups regarding left ventricular fractional shortening (30 +/- 10 % and 33 +/- 13%, P = 0.630), rheumatic valvular disease (5% and 12%, P = 0 .301), left atrial diameter (43 +/- 7 and 45 +/- 8 mm, P = 0.134), right at rial area (16 +/- 4 and 17 +/- 6 cm(2), P = 0.384), left atrial SEC (39% an d 53%, P = 0.124), or atrial thrombus (2% and 3%, P = 0.888) respectively. Our results point to the high prevalence of protruding atherosclerotic plaq ues in the thoracic aorta in patients with atrial flutter.