Predictive value of inflammatory and hemostatic parameters, atherosclerotic risk factors, and chest X-ray for aortic arch atheromatosis

Background and Purpose - Aortic arch atheromatosis ( AAA) is a common cause of cerebral embolism. Transesophageal echocardiography ( TEE) shows not only the extension of atherosclerotic plaques but also the mobility of superimposed thrombi. In most cases AAA is only detected after the embolic event. This study was therefore designed to identify predictive factors for AAA. Methods - One hundred seven consecutive patients referred for routine TEE were included in the study. Patients on warfarin therapy, with a history of recent surgery, or with any signs of infectious, immunological, or malignant diseases were excluded. Results - Diabetes mellitus carried the highest risk for AAA ( odds ratio, 3.0), followed by hyperlipidemia (2.5) and arterial hypertension (2.3). Age > 70 years was accompanied with a 1.8-fold increased risk. Patients with aortic calcifications on standard chest x-ray had a 4.6-fold higher prevalence. Severe AAA was associated with higher levels of C-reactive protein (14.6 +/- 14.1 versus 4.9 +/- 7.2 mg/L), fibrinogen (4.20 +/- 1.22 versus 3.45 +/- 1.29 mg/L), plasmin/antiplasmin complexes (728 +/- 297 versus 453 +/- 243 mug/L), and D-dimers (980 +/- 652 versus 444 +/- 349 mug/L). Conclusions - AAA is accompanied by elevation of inflammatory and hemostatic parameters. Patients with classic cardiovascular risk factors and aortic calcifications on chest x-ray have a higher prevalence. Further prospective studies are now warranted to establish a risk score to identify patients in whom TEE screening should be undertaken.