Prediction of coronary artery disease by transesophageal echocardiographic assessment of thoracic aorta atherosclerosis

Background: It has been shown that the presence of aortic atherosclerotic plaques is associated with an increased risk of coronary artery disease and myocardial ischemia. The purpose of the study was to establish the value of combined thoracic aorta atherosclerosis and decreased aortic elastic properties to predict the existence of obstructive coronary artery disease. Methods: Forty-four patients (pts) aged 46 to 74 years were studied with multiplane transesophageal echocardiography (TEE). Thoracic aorta atherosclerosis was diagnosed by increased echodensity of the intima with well defined atheroma protruding in the aortic lumen. Tissue Doppler imaging (TDI, Toshiba corp.) during TEE was used for the quantification of aortic elastic properties. The descending aorta was visualized in a TEE short axis view at the level of the left atrium and TDI was used for the rates of velocity change (dV/dt) over time. Peak positive dV/dt (dV/dt max, cm2sec-1) was measured. Results were compared to angiographically documented coronary artery stenosis (>50% diameter stenosis of any major branch). Results: 19/44 pts had proved coronary artery disease (CAD). dV/dt max was 7.82±1.79 in pts without CAD and 4.43±1.34 in pts with CAD (p<0.005). Aortic plaque > 3 mm was detected in 17/19 pts with CAD and 5/25 pts without CAD. dV/dt max < 5.5 cm2 sec–1 combined with atheroma > 3 mm on thoracic aorta had a sensitivity of 92%, specificity of 70% and positive predictive value of 85% for predicting presence of CAD. Conclusion: Our results indicate that these described combined methods are highly predictive for the existence of obstructive coronary artery disease.