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. 2021 Jul 1;28(7):776-785.
doi: 10.5551/jat.58339. Epub 2020 Sep 10.

Complex Aortic Arch Atherosclerosis in Acute Ischemic Stroke Patients with Non-Valvular Atrial Fibrillation

Masayuki Suzuki  1 , Kohei Furuya  1 , Misato Ozawa  1 , Kumiko Miura  1 , Tadashi Ozawa  1 , Kosuke Matsuzono  1 , Takafumi Mashiko  1 , Reiji Koide  1 , Shigeru Fujimoto  1 , Ryota Tanaka  1   2
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Complex Aortic Arch Atherosclerosis in Acute Ischemic Stroke Patients with Non-Valvular Atrial Fibrillation

Masayuki Suzuki et al. J Atheroscler Thromb. .

Abstract

Aim: Aortic arch atherosclerosis, particularly complex aortic arch plaques (CAPs), is an important source of cerebral emboli. CAPs and atrial fibrillation (AF) often co-exist; however, the prevalence and risk of CAPs in acute ischemic stroke patients with AF is unclear.

Methods: In patients with acute ischemic stroke with non-valvular AF admitted to Jichi Medical University Hospital during April 2016 to September 2019, we retrospectively evaluated the presence of CAPs on transesophageal echocardiography (TEE).

Results: CAPs were observed in 41 (38.7 %) of 106 patients with non-valvular AF. Older age, diabetes mellitus, chronic kidney disease, low high-density lipoprotein cholesterol (HDL-C) levels, higher levels of glycohemoglobin A1c (HbA1c), higher CHADS2 and CHA2DS2-VASc scores, and intracranial or carotid artery stenosis were more frequently observed in CAPs-positive than in CAPs-negative patients. In multivariable analyses, older age (odds ratio [OR]: 1.2 per year increase; 95% confidence interval [CI]: 1.07-1.24; P＜0.0001), diabetes mellitus (OR: 4.7; 95%CI: 1.27-17.35; P＜0.05), and low HDL-C (OR: 0.95 per 1 mg/dl increase; 95%CI: 0.92-0.99; P＜0.01) were independent risk factors for CAPs. The prevalence of CAPs was age-dependent, and there was a significantly higher risk in patients aged either 75-84 years or ＞84 years than in those aged ＜65 (OR: 7.6; 95%CI: 1.50-38.62, and OR: 32.1; 95%CI: 5.14-200.11, respectively).

Conclusions: Even in patients with ischemic stroke with non-valvular AF, concomitant CAPs should be considered in older individuals and those who have diabetes or low HDL-C.

Keywords: Acute stroke; Complex aortic arch plaque; Diabetes mellitus; Low HDL-C; Non-valvular atrial fibrillation.

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Figures

Fig.1.
Fig.1.
Flow diagram of patient enrollment in the present study
Fig.2. Age dependent prevalence of complex aortic arch plaque (CAPs)
Fig.2. Age dependent prevalence of complex aortic arch plaque (CAPs)
There is a significant age-dependent increase in the prevalence of CAPs ( P ＜0.001).
See this image and copyright information in PMC

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