Aortic spontaneous echocardiographic contrast and hemostatic markers in patients with nonrheumatic atrial fibrillation.
OBJECTIVE
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).


METHODS
A cross-sectional study at a university hospital.


METHODS
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] and beta-thromboglobulin [beta-TG]), thrombotic status (thrombin-antithrombin III complex [TAT]), and fibrinolytic status (D-dimer and plasmin-alpha(2)-plasmin inhibitor complex [PIC]) were determined.


RESULTS
Forty-three 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 beta-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.
Nakagawa
Keiko
K
Second Department of Internal Medicine, Toyama Medical and Pharmaceutical University, Toyama, Japan.
Hirai
Tadakazu
T
Shinokawa
Noriko
N
Takashima
Shutaro
S
Nozawa
Takashi
T
Asanoi
Hidetsugu
H
Inoue
Hiroshi
H
D000368:Aged; D000990:Antithrombin III / Q000032:analysis; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging*; D001018:Aortic Diseases / Q000000981:diagnostic imaging; D001161:Arteriosclerosis / Q000000981:diagnostic imaging; D001281:Atrial Fibrillation / Q000097:blood* / Q000000981:diagnostic imaging*; D003430:Cross-Sectional Studies; D017548:Echocardiography, Transesophageal; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005342:Fibrinolysis; D006487:Hemostasis; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D010447:Peptide Hydrolases / Q000032:analysis; D010978:Platelet Factor 4 / Q000032:analysis; D014057:Tomography, X-Ray Computed; D001620:beta-Thromboglobulin / Q000032:analysis
D005338:Fibrin Fibrinogen Degradation Products; C046193:antithrombin III-protease complex; D001620:beta-Thromboglobulin; C036309:fibrin fragment D; D010978:Platelet Factor 4; D000990:Antithrombin III; D010447:Peptide Hydrolases