ABSTRACT
The aim of this study was to determine the relationship between spontaneous echocardiographic contrast in the descending thoracic aorta and plasma levels of platelet factor 4 [PF4] and D-dimer as hemostatic markers in patients with nonrheumatic atrial fibrillation. This study included 60 patients [mean age, 58 +/- 3 years; 34 males] with non-rheumatic chronic atrial fibrillation who underwent transesoph geal echocardiography Plasma levels of PF4 as. a measure of platelet activation and D-dimer as an index of thrombogenesis were determined on the day of TEE. 27 patients who had aortic spontaneous echocardiographic contrast [Ao-SEC] were older [61 years vs 57 years; p<0.05 than 33 patients without AoSEC. D-dimer levels were significantly higher in patients with AoSEC than in those without AoSEC, whereas PF4 was not different between the two groups. Although the prevalence of prior cerebral embolism did not differ between the two groups [22% in patients with AoSEC vs 18% in patients without AoSEC], the prevalence of peripheral arterial embolism was r in patients with AoSEC than in those without AoSEC [11% vs 0%; p<0.05]. The LA appendage peak flow velocity was significantly lower in patients with AoSEC than in those without AoSEC. The grade of LASEC and the prevalence of LA thrombi were higher in patients with AoSEC than those without. Although aortic dimensions did not differ between the two groups aortic atherosclerotic grade was greater in patients SEC than in those without AoSEC. Multivariate analysis revealed that mitral regurgitation, LASEC, and aortic atherosclerosis emerged as independent predictors of AoSEC. Search for AoSEC in addition to LA appendage dysfunction with TEE could provide valuable information on prothrombotic state in patients with nonrheumatic AF. Patients with nonrheumatic AF complicated with AoSEC could have enhanced thrombogenesis; therefore, intensive anticoagulation with oral warfarin may be recommended for these patients