Echocardiographic risk stratification for ischemic stroke in non‐rheumatic atrial fibrillation: Importance of aortic plaques detected by transesophageal echocardiography*

Background: The aim of the present paper was to assess the prevalence of atherosclerotic aortic plaques in non‐rheumatic atrial fibrillation and their relation to ischemic stroke. Although aortic plaques are frequently seen in the elderly, their significance remains unclear in relation to ischemic stroke in patients with atrial fibrillation. Methods: Transesophageal echocardiography was performed on 56 patients (age 61 ± 10 years) with atrial fibrillation. The aorta was divided into two segments (i.e. the proximal aorta that includes the ascending aorta and the aortic arch proximal to the ostium of the left subclavian artery, and the distal aorta that is the descending aorta distal to the left subclavian artery). Thickened intima = 3 mm in thickness was defined as aortic plaques. Results: Ischemic stroke was found in 14 of the 56 patients. Aortic plaques were detected in 25 of the 56 patients. All of these 25 patients had aortic plaques in the proximal aorta, and 17 of them also had aortic plaques in the distal aorta. Ischemic stroke was found in 11 of the 25 patients (44%) with aortic plaques, and three of the 31 patients (10%) without aortic plaques (P < 0.01). Conversely, aortic plaques were detected in 11 of the 14 patients (79%) with ischemic stroke, and in 14 of the 42 patients (33%) without (P < 0.01). The patients with ischemic stroke had a larger left atrium (47 ± 5 vs 43 ± 6 mm; P < 0.05) than those without. Aortic plaques were a correlate only of previous ischemic stroke (P < 0.05) by multiple logistic regression analysis. Conclusions: Atherosclerotic aortic plaques detected by transesophageal echocardio‐graphy are a correlate of previous ischemic stroke in patients with non‐rheumatic atrial fibrillation.