Transesophageal Echocardiographic Detection of Thoracic Aortic Plaque Could Noninvasively Predict Significant Obstructive Coronary Artery Disease

Abstract

ObjectivePrevious pathologic and roentgenographic studies have suggested a relation between aortic plaque and coronary artery disease but have lacked clinical utility. The study was undertaken to elucidate whether atherosclerotic aortic plaque detected by transesophageal echocardiography can be a clinically useful marker for significant obstructive coronary artery disease.MethodsClinical and angiographic features and intraoperative transesophageal echocardiographic findings were prospectively analyzed in 131 consecutive patients (58 women and 73 men, aged 17 to 75 years [mean 54±12]) undergoing open heart surgery. Significant obstructive coronary artery disease was defined as > or = 50% stenosis of > or = 1 major branch.ResultsSeventy-six (58%) of 131 patients were found to have obstructive coronary artery disease. In 76 patients with significant coronary artery disease, 71 had thoracic aortic plaque. In contrast, aortic plaque existed in only 10 of the remaining 55 patients with normal or minimally abnormal coronary arteries. The presence of aortic plaque on transesophageal echocardiographic studies had a sensitivity of 93%, a specificity of 82% and positive and negative predictive values of 88% and 90%, respectively, for significant coronary artery disease. There was a significant relationship between the degree of aortic intimal changes and the severity of coronary artery disease (r=0.74, P<0.0001). Multivariate logistic regression analysis of patient age, sex, risk factors of cardiovascular disease and transesophageal echocardiographic findings revealed that atherosclerotic aortic plaque was the most significant independent predictor of coronary artery disease.ConclusionThis study indicates that transesophageal echocardiographic detection of atherosclerotic plaque in the thoracic aorta is useful in the noninvasive prediction of the presence and severity of coronary artery disease.

The Relation between the Color M‐Mode Propagation Velocity of the Descending Aorta and Coronary and Carotid Atherosclerosis and Flow‐Mediated Dilatation

“…Similarly, Tribouilloy et al reported a sensitivity of 95% and a specificity of 88% with positive and negative predictive values of 64% and 99%, respectively 15 . In another study, the presence of aortic plaque on TEE had a sensitivity of 93% and a specificity of 82% and positive and negative predictive values of 88% and 90%, respectively, for significant CAD 16 . However, the performance of TEE for risk assessment in CAD is not feasible in daily practice and AVP may be an indirect sign of the atherosclerotic involvement of the thoracic aorta.…”

“…However, there is a growing body of evidence suggesting that aortic atheroma may be a marker of generalized atherosclerosis 14 . A strong association between the presence and severity of thoracic aortic plaque imaged by transessophageal echocardiography (TEE) and the presence and extent of CAD has been identified 15,16 . In a group of patients selected to have a high prevalence of CAD (67%), Fazio et al reported that the presence of atherosclerotic plaque in the thoracic aorta was a marker for significant CAD at angiography with a sensitivity of 90% and a specificity of 90% (positive predictive value 95%, negative predictive value 82%) 4 .…”

Predicting the presence of coronary artery disease by transesophageal echocardiography

“…Previous data have shown differing results, partly with significantly better results regarding the prognostic value of echo findings; however, the study designs differed tremendously. Some studies considered a coronary artery stenosis of at least 50% to be significant [ 18 , 19 , 21 ], another study was retrospective and with few patients [ 20 ].…”

“…The absence of atherosclerosis in the thoracic aorta resulted in a negative predictive value of 90-99% for the presence of significant CAD in a number of previous studies [18][19][20][21]. Gu et al showed that the presence of aortic plaques, especially those in the descending aorta, are associated with the presence of significant CAD [22].…”

A Cerebrovascular Incident Secondary to Extensive Aortic Arch Atheroma

“…Atherosclerosis of aortic arches can lead to systematic embolization if dislodged with numerous studies finding a strong association between the two [ 2 , 3 ]. Aortic arch atheroma begins to appear in early adulthood and increases with age, hypercholesterolemia, hypertension, diabetes mellitus, increased homocysteine and fibrinogen, and being of the male sex among others [ 4 , 5 ]. It alone causes increases the odds ratio of having a stroke by more than four, and if mobile, the odds increase by more than 12 [ 4 ].…”