Improved detection of spontaneous echo contrast in the aorta with tissue Doppler imaging

Aims: Spontaneous echo contrast (SEC) within the cardiac chambers has been associated with increased risk of thromboembolism. We investigated the presence and severity of SEC in the aorta with tissue Doppler imaging (TDI) and compared these to the aortic flow velocity and to the clinical profile of the patients. Methods and Results: Seventy patients (35 males, 35 females, mean age 64, 22-86 years) underwent TEE for standard indications. Spontaneous echo contrast was studied with conventional and TDI imaging. Aortic flow velocity was measured in the center and lateral part of the descending aorta. SEC of any grade was detected in 24 patients with conventional imaging and in 53 using TDI (P < 0.0001). The presence of swirling was associated with aortic atherosclerosis, older age, history of hypertension and coronary artery disease, atrial fibrillation, and previous embolic events. There was correlation between intraaortic swirling, larger descending aortic diameter (23.6 vs 17 mm, P < 0.00001) and lower peak aortic flow velocity (55 vs 68 cm/s, P = 0.038). Conclusion: Spontaneous echo contrast in the aorta is common in high-risk patients and is associated with increased clinical profile, larger aortic diameter, and lower peak aortic flow velocity. Tissue Doppler imaging is more sensitive in the detection of SEC than conventional imaging.