The impact of aortic atherosclerotic plaques (ASP) demonstrated by transesophageal echocardiography (TEE) is controversial. It is also unclear whether the severity of ASP correlate with embolic events. The purpose of this study was to investigate the incidence of embolic events in different grades of ASP.
We studied 277 consecutive patients (male/female=153/124, age 66.2±13.4 years) without left atrial thrombus by TEE. The thoracic aortic plaque severity was classified as Grade I (normal or minimal intimal thickening) in 86; Grade II (extensive intimal thickening) in 105; Grade III (atheroma < 5mm) in 70; Grade IV (atheroma ≥ 5mm) in 11; and Grade V (mobile lesion) in 5 patients. The incidence of embolic events, mortality and clinical characteristics were evaluated in patients with different grades of ASP.
The incidence of embolic events was increased with the severity of ASP (Grade II, 12%, Grade III, 16%, Grade IV, 27% and Grade V, 60%). Grade ≥ IV had the highest incidence of embolic events (6/16, 38%) compared to grade I (11/86, 13%) (p=0.038). There was no significant difference in age, left atrial diameter, spontaneous contrast echo in left atrium, left ventricular ejection fraction and the prevalence of coronary artery disease, old myocardial infarction, aortic stenosis, aortic valve calcification, mitral annulus calcification and left ventricular hypertrophy between the groups (p>0.05). There was no significant difference in the percentage of patients with therapuetic anticoagulation or antiplatelets between the ASP groups. During the follow-up of 38.7±32 months, there was no significant difference in cardiac mortality between the groups (p>0.05).
The incidence of the embolic events is related to the severity of ASP. There was significant increase in the embolic events in patients with grade ≥IV ASP.
ASP detected by TEE is associated with embolic events and there is significant increase in the embolic events in patients with grade ≥ IV ASP.
Chandra Nair, None.