1021-60 Patients Presenting with Systemic Emboli are Often Found to Have Mobile Plaque In the Aortic Arch by Transesophageal Echocardlography (TEE)

Abstract

Although the mobile component of plaque is thought to represent thrombus, the efficacy of anticoagulation has not been proven. In order to assess the influence of anticoagulation in this population. we studied 29 pts with mobile plaques found by TEE interrogation of the aortic arch. Each pt had had a recent systemic embolism: cerebral in 27 (93%) and peripheral in 2 (7%). After TEE, pt treatment was determined by physician preference. Followup (mean 13 ± 12 mo.s) was obtained via telephone interview and chart review. Of the 29 pts studied, 19 (66%) received warfarin (WAR) and 10 (34%) received either aspirin (7) or no therapy(3). These groups were compared in regards to dimensions of both mobile and immobile plaque components and vascular events: Plaque Dimensions Vascular Event Immobile Component Mobile Component Height Width Area Height Width Area WAR(n = 19) 7 ± 3 29 ± 13 13 ± 6 8 ± 9 3 ± 3 5 ± 8 0 No WAR (n = 10) 6 ± 2 30 ± 15 12 ± 8 7 ± 4 3 ± 2 2 ± 3 6 (60%) P NS NS NS NS NS NS 0.0009 The dimensions of both mobile and immobile components of plaque were similar in the groups. Vascular events occurred in 6 (60%) of the No WAR group (4 strokes and 2 myocardial infarctions) while none of the pts receiving warfarin had an event (p = 0.0009). Similarly when pts with and without vascular events were compared, no differences in plaque dimensions were found. In conclusion, mobile aortic plaque is associated with a high frequency of vascular events during a relatively brief period of follow-up. Although no morphologic aspect of the plaque predicts an event, it appears that warfarin may provide adequate prophylaxis.