Abstract
The purpose of this study was to assess whether the detection of atherosclerotic aortic plaques by transoesophageal echocardiography (TEE) could be used as a marker of coronary artery disease (CAD), relying on their number, cross-sectional surface, depth and localisation. The thoracic aortas of 102 consecutive patients (77 men, mean age 67 +/- 12 years) undergoing elective cardiac surgery were assessed by TEE. Atherosclerotic plaques were defined as > or = 5 mm thick focal hyperechogenic zones of the aortic intima and/or lumen irregularities with mobile structures or ulcerations. All patients had undergone prior coronary angiography. Thoracic aortic plaques were present in 73 patients, 66 of whom had CAD. The presence of aortic plaques detected by TEE identified significant coronary artery disease with a sensitivity of 90% and a specificity of 76%. The maximum transverse cross-sectional plaque area, the maximum plaque depth and the total plaque number all correlated significantly with the presence of CAD, but not with its severity. Multivariate regression analysis showed that aortic plaques, hypertension and hypercholesterolaemia were significant predictors of CAD, but aortic plaques were the most significant predictor regardless of age and sex. This study suggests that detection of atherosclerotic aortic plaques is a useful marker of significant coronary artery disease. Absence of plaques in the patients aged over 70 identified a subgroup with a very low probability of CAD.
Highlights
Transoesophageal echocardiography (TEE) allows detection of atherosclerotic intimal lesions in the thoracic aorta [1,2,3]
The purpose of this study was to assess whether the detection of atherosclerotic aortic plaques by transoesophageal echocardiography (TEE) could be used as a marker of coronary artery disease (CAD), relying on their number, cross-sectional surface, depth and localisation
Thoracic aortic plaques were present in 73 patients, 66 of whom had CAD
Summary
Transoesophageal echocardiography (TEE) allows detection of atherosclerotic intimal lesions in the thoracic aorta [1,2,3]. Previous studies have shown that the presence of atherosclerotic aortic plaques is a strong independent predictor of coronary artery disease and of embolic events [4,5,6,7,8,9,10,11,12]. The high potential risk of embolism posed by complex aortic plaques can be successfully diminished by using targeted approaches before cardiac surgery and invasive coronary procedures [13,14,15]. Previous reports have relied mainly on qualitative information, based on the presence or absence of simple or complex aortic plaques. Quantitative characteristics and distribution of thoracic aortic plaques imaged by TEE and its predictive value for coronary artery disease (CAD) are less well defined. Some authors have reported that the majority of aortic plaques are located in the descending thoracic aorta and the aortic arch, and that few or none are found in the ascending thoracic aorta [2, 16]
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