(Stroke. 1999;30:834-840.)
© 1999 American Heart Association, Inc.
Original Contributions |
Aortic Plaque in Atrial Fibrillation
Prevalence, Predictors, and Thromboembolic Implications
From the Mayo Clinic Jacksonville, Jacksonville, Fla (J.L.B); Statistics and Epidemiology Research Corporation, Seattle, Wash (L.A.P.); University of Texas Health Science Center, San Antonio, Tex (R.G.H., M.Z.); St Louis University Medical Center, St Louis, Mo (A.L.); Hennepin County Medical Center, Minneapolis, Minn (R.W.A.); and Mt Sinai Medical Center, New York, NY (J.L.H.).
Correspondence to Joseph L. Blackshear, MD, Division of Cardiovascular Diseases, Mayo Clinic Jacksonville, 4500 San Pablo Rd, Jacksonville, FL 32224. E-mail jlb16{at}exjax.mayo.edu
Background and Purpose—Thoracic aortic plaque identified by transesophageal echocardiography heightens the risk of stroke associated with atrial fibrillation (AF). We sought to identify the prevalence, predictors, and implications 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 simple or
complex on the basis of thickness 
4 mm, ulceration, or mobility.
Clinical and echocardiographic features of
thromboembolism 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 than in the proximal aorta. Potentially etiologic
patient characteristics independently associated with complex plaque
included advanced age, history of hypertension, diabetes, and past or
present tobacco use. Comorbidities associated with aortic plaque
were prior thromboembolism, increased pulse pressure, ischemic
heart disease, stenosis or sclerosis of the aortic valve,
mitral 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 years with <10%
mitral annular calcification, without ischemic heart disease,
or without pulse pressure 65 mm Hg was 4% (95% CI, 1% to
6%).
Conclusions—Aortic plaque is prevalent in patients with AF and is associated with atherosclerosis risk factors and with left atrial stasis or thrombosis, which are themselves independent stroke risk factors. Since the predominant location of complex plaque was in the descending aorta, the role of aortic plaque as a source of embolism in AF is uncertain.
Key Words: aorta • atherosclerosis • atrial fibrillation
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