Frequency and Distribution of Atherosclerotic Plaques in the Thoracic Aorta as Determined by Transesophageal Echocardiography in Patients With Coronary Artery Disease

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Abstract

The frequency, distribution, and severity of thoracic aortic plaques were evaluated by transesophageal echocardiography in 152 consecutive patients undergoing coronary arteriography. Coronary artery disease (CAD) was defined as ≥50% stenosis of ≥1 major branch. Atherosclerotic plaques were detected in the aorta in 90 of the 97 patients (93%) with CAD, but in only 12 of the 55 patients (22%) with normal coronary arteries. Atherosclerotic plaques in patients with CAD were found predominantly in the descending aorta (in 93%) and in the aortic arch (in 80%), whereas the ascending aorta was the least involved (in 37%). In the descending aorta, 58% of the plaques were complex (>3 mm thick, ulcerated, mobile, or calcified), and in the aortic arch, 40% of the plaques were so classified. Complex plaques were not found in the ascending aorta. The presence of an atherosclerotic plaque in the descending aorta had a sensitivity and a specificity for the prediction of CAD of 93% and 78%, respectively. In the ascending aorta, the sensitivity was lower (37%) but the specificity was higher (100%). The sensitivity of aortic plaques for the prediction of CAD was high in all age groups. Its specificity in subjects >63 years was lower than in younger subjects: 64% versus 90%, respectively. Multivariate logistic regression analysis showed that aortic plaques were a stronger predictor of CAD than were conventional risk factors.

This study demonstrates that aortic atherosclerosis, as detected by transesophageal echocardiography, is a powerful and stronger predictor of coronary artery disease than conventional risk factors. Aortic plaques were found in 93% of patients with coronary artery disease but in only 22% of subjects with normal coronary arteries.

Section snippets

Methods

Between January and March 1993, 165 consecutive patients, aged 30 to 90 years, were admitted for coronary angiography either for suspected CAD or for valvular or primary myocardial disease. Ten patients with coronary irregularities but with <50% luminal stenosis were excluded from the study. One hundred fifty-two patients gave informed consent to perform transesophageal echocardiography and were studied prospectively. The mean age was 62 ± 11 years, and 100 (66%) were men. Sixty-four patients

Aortic Plaques

Transesophageal echocardiography detected grades II to IV atherosclerotic plaques in the thoracic aorta in 90 of the 97 (93%) patients with CAD and in 12 of the 55 patients (22%) with normal coronary arteries. In patients with CAD, the plaques were most frequent in the descending aorta; the ascending aorta was the least involved (Table 1). In patients with CAD, complex aortic plaques (grades III and IV) were found in the descending aorta and arch, but not in the ascending aorta (Table 2).

The

Discussion

In an earlier study, the presence of atherosclerotic plaques in the aorta seen on transesophageal echocardiography had a sensitivity and a specificity of 90% for angiographically proven CAD.[18]The present study demonstrated that atherosclerotic plaques detected by transesophageal echocardiography in the descending aorta and aortic arch were good predictors of CAD, but not those detected in the ascending aorta. Plaques in the ascending aorta were found mainly in patients with multivessel CAD.

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