title: Clinical characteristics of complex aortic plaque in patients with non-valvular atrial fibrillation.
abstract: BACKGROUND
  Although complex aortic plaque (CxAoP) is a component of the CHA2DS2-VASc score in patients with atrial fibrillation (AF), it is underestimated without detection by trans-esophageal echocardiogram (TEE). We have evaluated the incidence and significance of CxAoP among patients with non-valvular AF (NVAF).
  
  
  METHODS
  We included 981 patients with NVAF who underwent catheter ablation (59.1±11.1years old, 73.7% male, 70.2% paroxysmal AF). All of the patients underwent pre-procedural TEE evaluation. Left atrial (LA)-cardioembolic (CE) milieu was defined as a dense spontaneous echo-contrast or LA appendage flow velocity≤20cm/s.
  
  
  RESULTS
  CxAoP was present in 8.3% of patients, and independently associated with age (OR 1.07, 95% CI 1.03-1.10, p<0.001), male sex (OR 2.34, 95% CI 1.29-4.24, p=0.005), and CHA2DS2-VASc score≥2 (OR 3.33, 95%CI 1.42-7.77, p=0.005). The presence of LA-CE milieu overlapped with CxAoP in only 11% of patients. Patients with CxAoP had a higher prevalence of hypertension (p=0.004), smoking history (p=0.008), paroxysmal AF (PAF, p<0.001), and a smaller LA volume index (p<0.001) than those with LA-CE milieu. The prevalence of persistent AF among patients with a history of stroke was significantly lower in the presence of CxAoP than in those with LA-CE milieu (p=0.014). CHA2DS2-VASc score was underestimated in 11% of high-risk patients (CHA2DS2-VASc score≥2) due to undetected CxAoP.
  
  
  CONCLUSIONS
  CxAoP may contribute to the risk of stroke by a different mechanism than LA-CE milieu in patients with NVAF. Imaging assessment for CxAoP affects thromboembolic risk stratification and decision making for stroke prevention in patients with NVAF.
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Pil-Sung
authors.initials: PS
authors.lastname: Yang
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Tae-Hoon
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Jae-Sun
authors.initials: JS
authors.lastname: Uhm
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Jong-Youn
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Boyoung
authors.initials: B
authors.lastname: Joung
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea.
authors.forename: Moon-Hyoung
authors.initials: MH
authors.lastname: Lee
authors.affiliation: Yonsei University Health System, Seoul, Republic of Korea. Electronic address: hnpak@yuhs.ac.
authors.forename: Hui-Nam
authors.initials: HN
authors.lastname: Pak
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000175:diagnosis*; D001281:Atrial Fibrillation / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D017115:Catheter Ablation; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000150:complications* / Q000175:diagnosis*; D018570:Risk Assessment
keywords: Atrial fibrillation; CHA(2)DS(2)-VASc score; Complex aortic plaque