P771 3D versus 2D transesophageal echocardiography in the detection of thoracic aorta atherosclerosis stage and prediction of coronary atherosclerosis

Abstract

Abstract Background 2D transesophageal echocardiography (TEE) was approved as a suitable method for the assessment of thoracic aorta (TA) atherosclerosis. Purpose A comparison between 2D and 3D multiplane TEE for qualitative and quantitative assessment of aortic atheromas and for coronary atherosclerosis prediction. Methods 180 consecutive CAD patients (104 men, 76 women, mean age 62 ± 7 years) were examined. 2D and 3D TEE was performed using Philips IE33 xMatrix system and a X7-2t multiplane probe. 2D study of TA was performed using Live xPlane mode. 3D study of TA was performed using Live 3D and Full Volume modes. Qualitative and quantitative assessment of every atheroma was performed using 2D and 3D modes. The degree of severity and distribution of the TA atheromatosis was evaluated according to the classification of ASE and EACVI (2015): grade 0 – intimal-medial thickness ≤1 mm, 1 – intimal thickness ≤2 mm, 2 – focal or diffuse intimal thickening of 2-3 mm (small atheromas), 3 – atheromas >3–5 mm (no mobile/ulcerated components), 4 - atheromas > 5 mm (no mobile/ulcerated components), 5 - grade 2, 3, or 4 atheromas plus mobile or ulcerated components. After TEE all patients underwent digital coronary angiography and SYNTAX Score was calculated. Findings were presented as M ± SD or n (%). Results 620 atheromas were analysed: 109 in the ascending part, 8 in the arch and 503 in the descending part. On average 3,43 ± 2,15 atheromas per patient were revealed. Atheromas height in 3D was significantly higher (p < 0,001), than in 2D, being 0,38 ± 0,09 mm and 0,26 ± 0,07 mm, respectively. Atheromas height increase in 3D was 0,12 ± 0,06 mm. In 3D 88% of atheromas have shown irregular contours while in 2D only 35% of atheromas had rough countors. The mobile component in 6 out of 9 atheromas was revealed only in 3D. In 2D 1-5 stages of TA atheromatosis were revealed in 22 (12%), 103 (57%), 43 (24%), 7 (4%) and 4 (2%) cases, respectively. In 3D 1-5 stages of TA atheromatosis were revealed in 16 (9%), 25 (14%), 90 (50%), 38 (21%) and 10 (5%) cases, respectively. With 3D TEE 72% of patients were found to have higher gradation of TA atheromatosis stage. The direct Spearman’s correlation between a stage of TA atheromatosis and SYNTAX Score which has been established for 2D r = 0,32 p < 0,001 and 3D r = 0,30, p < 0,01, respectively. Conclusions A comparison between 2D and 3D TEE has shown, that 3D is more precise method of qualitative and quantitative assessment of aortic atheromas and diagnosis of TA atheromatosis stage. 3D ultrasound stage of TA atheromatosis is a surrogate marker of severity and prevalence of coronary atherosclerosis.