Association between spontaneous echocardiographic contrast in descending aorta and platelet factor 4 and D-dimer in patients with non-rheumatic atrial fibrillation

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

Association between carotid intima-media thickness on ultrasonography and severity of coronary atherosclerosis

The aim of this study was to evaluate the usefulness of noninvasive assessment of common carotid artery [CCA] intima-media thickness [IMT] in prediction of presence and severity of coronary atherosclerosis. B-mode ultrasound of carotid arteries was performed on 80 patients [mean age 51 +/- 6 yrs., range 40-60: 43 were males] who had coronary angiography performed within 3 months. -4ccording to the results of coronary angiography patients were divided into control group [normal coronary angiography no=18] and coronary disease group [22 patients with single vessel disease and 40 patients with multivessel disease]. Diabetic patients and those with peripheral artery and cerebral vascular diseases were e-duded from the study. IMT less than 1.0 mm was considered as normal. IMT equal or more than 1.0 mm was considered as initial atherosclerotic lesion of carotid arteries, and IMT more or equal to 2.0 was considered as a sign of mild carotid plaque

Results: the IMT of the common carotid artery in coronary heart disease group and in control group was 1.05 +/- 0.65mm and 0.58 +/- 0.20mm respectively, [P<0.00l].There was no any sign of carotid atherosclerosis in the majority of patients without overt coronary lesions [control group]: 88.9% of them 11ad normal [< 1.0 mml carotid IMT. The remaining 11.1 % of patients of this group showed only moderate thickness [< 2.0 mm], and no one had signs of carotid plaque [IMT more than 2.0 mm]. Single-vessel disease was associated with significant increase of IMT. Signs of carotid atherosclerosis were observed in 3 1.8% of patients [22.7% with IMT 1.0- 2.0 mm, and 9.1% with IMT more than 2.0 mm], albeit 68.2% of patients had normal IMT. 62.5% of patients having multivessel disease have had signs of carotid atherosclerosis on ultrasound examination. 30% of them showed IMT more than or equal to 1.0 mm while in 32.5% of them carotid ultrasound detected severe increase of IMT [more than or equal to 2.0 mm]. Only 37.5% of patients had normal carotid IMT. The sensitivity of IMT 1 .0-2.0 mm in multi-vessel CAD was 62% with specificity 86%. Using criterion IMT more than 2.0mm the specificity dramatically rose to 95%, whereas sensitivity lowered to 32%

Conclusions: the common carotid artery IMT measured by simple, noninvasive method is greater in patients with coronary artery disease as compared with that in patients without the disease. IMT showed good correlation with the severity of coronary atherosclerosis, especially in patients with multi-vessel disease, having worse long-term prognosis. The ultra-sonographic screening of carotid arteries thus offers a valuable complement to other noninvasive tests used for the initial identification of patients with ischemic heart disease. However, standardized protocol for IMT measurements is needed before it can be widely implemented in the clinical practice