Letters to the EditorComplex Atheroma on Transesophageal Echocardiography Abdulhamid J. KinsaraMRCP, ABIM Abdulhamid J. Kinsara Consultant Cardiologist, King Khalid National Guard Hospital, P.O. Box 4409, Jeddah 21491, Saudi Arabia, E-mail: Search for more papers by this author Email the corresponding author at [email protected] Published Online:1 May 2002https://doi.org/10.5144/0256-4947.2002.259SectionsPDF ToolsAdd to favoritesDownload citationTrack citations ShareShare onFacebookTwitterLinked InRedditEmail AboutIntroductionTo the Editor: We have read with interest the paper by Ismail et al. which we found stimulating as we have also encountered a similar case.1 We would like to share with readers some of our observations which we consider important. The authors used a cut-off of 5 cm for simple a atheroma of <5 mm. Most studies actually use 4 mm including the two original articles that address this issue.2–4They also defined complex atheroma as intimal thickening >5 mm with raised, protruding, ulcerated or mobile plaques. However, the consensus in the literature is that the size is not the absolute criterion for designating a lesion as a complex atheroma. Indeed, any lesion that is mobile or ulcerated can still be designated as complex irrespective of its size. In addition, any of them has a high risk of subsequent vascular events.5The authors also did not define the age at which the presence of atherosclerotic lesions in the thoracic aorta is a strong predictor of coronary artery disease (CAD), since it has been described only in patients <70 years old.6 I would like to point out that a recent prospective study indicated that TEE examination of thoracic atherosclerotic plaque is a powerful predictor of absence of significant CAD in patients with valvular heart disease, namely, aortic stenosis.7 It would have been interesting if the author had included other landmarks during the study like mitral annular calcification. Mitral annular calcification, combined with aortic plaque, is highly predictive not only for strokes, but also for deaths associated with cerebral embolism and total cardiac deaths. They are probably strong markers for higher severity of coronary artery disease. The two are more predictive if both are present simultaneously compared to the presence of either alone.8The value of the publication would have increased considerably if the authors had been able to provide the results of homocysteine or fibrinogen level in the blood as either could be independent predictor of the presence and severity of thoracic aortic atherosclerosis.9 We hope the comments on this interesting publication will be of interest to the readers and help generate more information.ARTICLE REFERENCES:1. Ismail M, El-Gamal A, Ibraheim A. "Aortic plaque on transesophageal echocardiography as a marker for coronary artery disease" . Ann Saudi Medicine. 2000; 20:461–3. Google Scholar2. Amarenco P, Duyckaerts C, Tzourio C, Henin D, Bousser MG, Hauw JJ. "The prevalence of ulcerated plaques in the aortic arch in patients with stroke" . N Engl J Med. 1992; 326:221–5. Google Scholar3. The French Study of Aortic Plaques in Stroke Group. "Atherosclerotic disease of the aoritic arch as a risk factor for recurrent ischemic stroke" . N Engl J Med. 1996; 334:1216–21. Google Scholar4. Zabalgoitia M, Halperin JL, Pearce LA, Blackshear JL, Asinger RW, Hart RG. "Transesophageal echocardiographic correlates of clinical risk of thromboembolism in nonvalvular atrial fibrilation. Stroke Prevention in Atrial Fibrilation III Investigators" . J Am Coll Cardiol. 1998; 31:1622–6. Google Scholar5. Geraci A, Weinberger J. "Natural history of aortic arch atherosclerotic plaque" . Neurology. 2000; 54:749–51. Google Scholar6. Parthenakis FI, Kochiadakis GE, Skalidis EI, Kanakaraki MK, Mezilis NE, Kanoupakis EM, et al.. "Aortic atherosclerotic lesions in the thoracic aorta detected by multiplane transesophageal echocardiography as a predictor of coronary artery disease in elderly patients" . Clin Cardiol. 2000; 23:734–9. Google Scholar7. Tribouilloy C, Peltier M., Rey JL, Ruiz V, Lesbre JP. "Use of transesophageal echocardiography to predict significant coronary artery disease in aortic stenosis" . Chest. 1998; 113:671–5. Google Scholar8. Kamensky G, Lisy L, Polak E, Piknova E, Plevova N. "Mitral annular calcifications and aortal plaques as predictors of increased cardiovascular mortality" . JCardiol. 2001; 37(Suppl 1):21–6. Google Scholar9. Tribouilloy CM, Peltier M, Iannetta Peltier MC, Trojette F, Andrejak M, Lesbre JP. "Plasma homocysteine and severity of thoracic aortic atherosclerosis" . Chest. 2000; 118:1685–9. Google Scholar Previous article Next article FiguresReferencesRelatedDetails Volume 22, Issue 3-4May-July 2002 Metrics History Published online1 May 2002 InformationCopyright © 2002, Annals of Saudi MedicinePDF download