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Aortic Atherosclerosis Detection on Transesophageal Echocardiography is Associated with Left Atrial Appendage

Samah AlKharji1, Mohamed Al Rawahi1, Ahmed AlTurki1

  • 1Division of Cardiology, McGill University Health Centre Montreal, Quebec, Canada.

Arrhythmia & Electrophysiology Review
|September 18, 2025
PubMed

Insights

Aortic atherosclerosis (AA) predicts left atrial appendage thrombus (LAAT) in patients with low CHA2DS2-VASc scores. Assessing AA on transoesophageal echocardiography (TOE) may improve stroke risk stratification for atrial fibrillation (AF) patients.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Medical Imaging

Background:

  • Elevated CHA2DS2-VASc scores predict left atrial appendage thrombus (LAAT), but low-risk individuals also face stroke risk.
  • Aortic atherosclerosis (AA) is linked to increased stroke risk and has been overlooked in cardiovascular risk scores.
  • Transoesophageal echocardiography (TOE) can visualize AA, a potentially significant 'vascular' variable.

Purpose of the Study:

  • To determine the prevalence of LAAT in patients with low thromboembolic risk (CHA2DS2-VASc score ≤1).
  • To investigate the correlation between aortic atherosclerosis (AA) and LAAT in this low-risk population.
  • To evaluate AA as a predictor of LAAT in patients with low CHA2DS2-VASc scores.

Main Methods:

  • Retrospective review of 592 transoesophageal echocardiograms (TOEs) from 2012-2017 for patients undergoing electrophysiology procedures.
  • Assessment of aortic atherosclerosis (AA) using Katz score, ASE grade, and Ferrari score.
  • Logistic regression and ROC curve analysis to identify LAAT predictors in patients with CHA2DS2-VASc score ≤1.

Main Results:

  • Among 249 patients with CHA2DS2-VASc scores ≤1, 7.5% had LAAT.
  • Aortic atherosclerosis (AA) burden, quantified by the Katz score, was an independent predictor of LAAT in patients with low CHA2DS2-VASc scores (AUC 0.76).
  • AA visualized on TOE was significantly associated with increased LAAT risk in this low-risk group.

Conclusions:

  • Aortic atherosclerosis (AA) detected by TOE is a significant predictor of left atrial appendage thrombus (LAAT) in patients with low CHA2DS2-VASc scores.
  • Incorporating AA assessment into risk stratification may improve clinical decisions regarding anticoagulation for atrial fibrillation (AF) patients.
  • Further research is needed to explore other imaging modalities for AA detection and its role in stroke risk assessment.
Abstract

Keywords:
Atrial fibrillationleft atrial appendage thrombustransoesophageal echocardiography

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