Clinical and Echocardiographic Determinants of Spontaneous Echocardiographic Contrast in the Descending Aorta Association with Embolic Events in Patients with Dilated Cardiomyopathy

Spontaneous echocardiographic contrast (SEC) is a frequent finding in patients with dilated cardiomyopathy (DCMP) and it is associated with embolic events when it occurs in the left atrium. However, little is known about SEC in the descending aorta (DA-SEC) and its associations with embolic events. In this study, we investigated the frequency and clinical correlates of DA-SEC and its association with peripheral embolic events after 16-months? follow-up. Sixty-seven consecutive patients with DCMP (47 male, 20 female, mean age 60±11 years) underwent transthoracic and transesophageal echocardiography. Spontaneous echocardiographic contrast in the descending aorta was found in 26 patients (38%) and was associated with lower cardiac index (p<0,001), left atrial SEC (p<0.001), left ventricular SEC (p<0.007), larger aortic root (p<0.009), and complex aortic atherosclerosis (p<0.001). Age, gender, presence of coronary artery disease, diabetes mellitus and hypertension were not associated with DA-SEC in this study group. In multivariate analysis, factors that were associated with DA-SEC were aortic atherosclerosis (p=0.04) and cardiac index (p=0.009). Eight of the patients (12%) died due to sudden death or terminal heart failure and 5 patients (7%) experienced non-fatal cerebrovascular embolic events in the follow-up period. Four of the patients with clinical embolic events had DA-SEC, whereas aortic atherosclerosis was present in all of these patients. Other peripheral embolic events were not observed in the study group. Spontaneous echocardiographic contrast in the descending aorta can often be detected by transesophageal echocardiography in DCMP patients and is associated with aortic atherosclerotic plaques, higher frequency of SEC in other cardiac chambers and low cardiac index. Although total number of embolic events is not very high, they seem to be more likely associated with aortic complex or calcific atherosclerotic plaques rather than DA-SEC.