Multiplane transoesophageal echocardiographic absence of thoracic aortic plaque is a powerful predictor for absence of significant coronary artery disease in valvular patients, even in the elderly: A large prospective study

AIMS: This study was conducted to examine whether detection of atheroscleroticaortic plaque by multiplane transoesophageal echocardiographycould predict the absence or presence of significant coronaryartery disease in young and elderly valvular patients. METHODS AND RESULTS: Clinical and angiographic features and transoesophageal echocardiographyfindings were prospectively analysed in 278 consecutive valvularpatients. In 93 patients with significant coronary artery disease,85 had thoracic aortic plaque on transoesophageal echocardiographystudies. In contrast, aortic plaque existed in only 33 of theremaining 185 patients with normal or mildly abnormal coronaryarteries. Therefore, the presence of aortic plaque on transoesophagealechocardiography studies had a sensitivity of 91%, a specificityof 82%, and positive and negative predictive values of 72% and95%, respectively, for significant coronary artery disease.In the 109 patients aged 70 years, these sensitivity, specificity,and positive and negative predictive values were 96%, 78%, 79%,and 96%, respectively. The above high negative predictive valuewas the major finding of this study and indicated that the absenceof thoracic plaque is a strong predictor for absence of significantcoronary artery disease. There was a significant relationshipbetween the degree of aortic intimal changes and the severityof coronary artery disease (P<0·0001). Multivariatelogistic regression analysis revealed that aortic plaque, angina,hypercholesterolaemia and age were significant predictors ofcoronary artery disease: aortic plaque was the most significantindependent predictor, even in patients 70 years. CONCLUSION: This large prospective study indicates that examination of thoracicatherosclerotic plaque, by multiplane transoesophageal echocardiography,is a marker for coronary artery disease, and is a particularlypowerful predictor for absence of significant coronary arterydisease in valvular patients, even in the elderly.