Objectives: To determine the relationship between
spontaneous echocardiographic contrast (SEC) in the descending thoracic
aorta and plasma levels of hemostatic markers in patients with
nonrheumatic atrial fibrillation (AF).
settings: A cross-sectional study at a university hospital.
Patients and measurements: In 91 consecutive patients
(mean ± SE age, 70 ± 1 years; 68 men) with nonrheumatic AF who
underwent transesophageal echocardiography, plasma levels of markers
for platelet activity (platelet factor 4 [PF4] andβ
-thromboglobulin [β-TG]), thrombotic status
(thrombin-antithrombin III complex [TAT]), and fibrinolytic status
(D-dimer and plasmin-α2-plasmin inhibitor complex[
PIC]) were determined.
patients who had aortic SEC (AoSEC) were older (72 years vs 68 years;
p < 0.05) and had a higher prevalence of chronic AF (88% vs 52%;
p < 0.05) than 48 patients without AoSEC. TAT, PIC, and D-dimer
levels were significantly higher in patients with AoSEC than in those
without AoSEC, whereas PF4 and β-TG levels were not different between
the two groups. Although the prevalence of cerebral embolism did not
differ between the two groups (23% vs 29%), the prevalence of
peripheral embolism was higher in patients with AoSEC than in those
without AoSEC (10% vs 0%; p < 0.05). Multivariate analysis
revealed mitral regurgitation (odds ratio, 7.53; p < 0.02), SEC in
the left atrium (odds ratio, 2.14; p < 0.02), and aortic
atherosclerosis (odds ratio, 1.87; p < 0.04) emerged as independent
predictors of AoSEC.
Conclusions: Patients with
nonrheumatic AF who have AoSEC appear to have enhanced coagulation
activity but not platelet activity. Intensive anticoagulation treatment
might be required for these patients.