Aortic pulse pressure and extent of coronary artery disease in percutaneous transluminal coronary angioplasty candidates

BACKGROUND: Pulse pressure and aortic stiffness are both predictors of coronary artery disease. Whether these parameters are directly related to coronary structural alterations has never been studied. METHODS: From September 1999 to September 2000, the following data were collected from 99 eligible patients: invasive intra-aortic systolic and diastolic blood pressures (BP), extent of coronary artery disease, cardiovascular risk factors, and the incidence of angiographically documented restenosis after coronary angioplasty. RESULTS: In the study population, independent determinants of aortic pulse pressure were age, gender, aortic mean BP, heart rate, and extent of coronary artery disease (r2 = 0.57, P < .0001). In univariate analysis, invasive aortic, but not noninvasive brachial, mean pressure (P = .017) and pulse pressure (P = .027) were significantly associated to the extent of coronary artery disease. In a multiple regression analysis, only male gender (P = .013) and the level of aortic pulse pressure (P = .023) were independently associated with the extent of coronary heart disease. Restenosis was angiographically documented in 11 patients (11%). There was a borderline significant association of restenosis to aortic mean BP (P = .05) and to a past history of multiple previous angioplasties (P = .03). CONCLUSIONS: In this study, aortic pulse pressure was a significant risk factor for the extent of coronary artery disease. There was only a borderline significant association of restenosis to the steady, but not pulsatile, component of aortic BP in the stent era.     

Relationship between aortic valve sclerosis and the extent of coronary artery disease in patients undergoing diagnostic coronary angiography

BACKGROUND: Aortic valve sclerosis (AVS) is considered to be a manifestation of coronary atherosclerosis. Recent studies demonstrated an association between AVS and significant coronary artery disease (CAD). AIM: We sought to determine the association between AVS and the extent of coronary atherosclerosis by means of the Gensini score system, which was calculated to yield a measure of the extent and severity of coronary atherosclerosis in patients referred for coronary angiography. METHODS: A total of 160 consecutive patients referred for coronary angiography were subjected to echocardiography for screening of AVS and coronary risk assessment. Absence (group 1, n = 110) and presence of AVS (Group 2, n = 50) was established. The cardiac risk factors considered in this study were age, gender, family history of CAD, diabetes mellitus, hypertension, hypercholesterolemia and history of smoking. The body mass index was also measured. Atherosclerotic plaque burden was determined using the Gensini score. Significant CAD was defined as >50% reduction in the internal diameter of at least one coronary artery. Multivessel coronary disease was based on the presence of 2- or 3-vessel disease. RESULTS: The AVS patients had a higher rate of 3-vessel disease (AVS group vs. non AVS: 40 vs. 13.6%; p < 0.001). No significant correlations were found between AVS and 1- and 2-vessel disease. Individuals with AVS were found to have a higher Gensini score (40.7 +/- 38.05 vs. 18 +/- 16.4; p < 0.001). Multivariate analysis identified age (p < 0.001), male sex (p = 0.01), triglycerides (p = 0.02), LDL cholesterol (p = 0.001) and Gensini score (p = 0.003) as independent predictors of AVS. CONCLUSION: AVS is strongly interrelated with the coronary angiographic Gensini score. Echocardiographic detection of AVS in patients undergoing coronary angiography can provide a new surrogate marker of the extent of coronary atherosclerosis.     

脉压与冠状动脉病变程度的关系

目的:探讨脉压(PP)与冠状动脉病变(CAD)程度的关系。方法:对515例因胸痛而住院的患者进行冠状动脉造影,分析确诊的338例冠心病患者和177例非冠心病患者的年龄、收缩压(SBP)、舒张压(DBP)、平均压(MAP)、PP和CAD支数等临床特点。结果:①与非冠心病患者相比,冠心病患者的年龄、SBP、MAP和PP均增加,男性和并发高血压病(EH)比例均增加(P0.05,P0.01)。②随着CAD支数的逐渐增加,年龄增加的变化,以及男性和并发EH比例增加的变化均有高度显著性差异(均P0.01);SBP和PP增加的变化有显著性差异(均P0.05)。与非冠心病患者相比,1支病变、2支病变和3支病变患者的年龄、SBP、MAP和PP增加,男性和并发EH比例均增加(P0.05,P0.01);3支病变与1支病变相比年龄增加(P0.05)。③随着PP的逐渐增加,冠心病患者的年龄、SBP、MAP和CAD支数均逐渐增加,并发EH比例亦逐渐增加,均有高度显著性差异(均P0.01);男性比例呈减低改变,有高度显著性差异(P0.01)。结论:PP水平与CAD有显著的关系:PP增大者,其CAD支数增加;而PP的增加与年龄和并发EH的增加有关。     

Fibrinogen-to-albumin ratio is related to the severity of coronary artery disease in chronic kidney disease patients undergoing coronary angiography

ObjectivesThis study was to explore the potential relationship between the fibrinogen-to-albumin ratio (FAR) and the presence and severity of coronary artery disease (CAD) in stage 3–5 predialysis chronic kidney disease (CKD) patients.DesignThis study included 978 patients undergoing coronary angiography (CAG). CAD was defined as the presence of obstructive stenosis > 50% of the lumen diameter in any of the four main coronary arteries. Gensini scores (GSs), left main coronary artery (LMCA) and three-vessel coronary artery disease (TVD) were used to elevate the severity of CAD.ResultsThe adjusted odds ratios of CAD were 3.059 (95% CI: 1.859–5.032) and 2.670 (95% CI: 1.605–4.441) in the third and fourth quartiles of FAR compared with the first quartile, respectively. Among 759 patients diagnosed with CAD, multivariate logistic regression analysis showed that FAR (at the 0.01 level) was significantly positively associated with the presence of LMCA (adjusted OR = 1.177, 95% CI 1.067–1.299, P = 0.001) or TVD (adjusted OR = 1.154, 95% CI 1.076–1.238, P < 0.001), and a higher GS (adjusted OR = 1.152, 95% CI 1.073–1.238, P < 0.001).ConclusionsFAR levels were independently associated with the presence and severity of CAD in stage 3–5 predialysis CKD patients.     

Aortic pulse wave velocity is associated with the presence and quantity of coronary artery calcium: a community-based study

We investigated the relationship of aortic pulse wave velocity (aPWV), a measure of central arterial stiffness, with the presence and quantity of coronary artery calcium (CAC) in a community-based sample of adults without prior history of heart attack or stroke (n=401, mean age 59.8 years, 53% men). ECG-gated waveforms of the right carotid and right femoral artery were obtained by applanation tonometry, and aPWV was calculated using established methods. CAC was measured noninvasively by electron beam computed tomography, and CAC score was calculated. aPWV was significantly correlated with log(CAC +1; r=0.41; P<0.0001) and pulse pressure (r=0.47; P<0.0001). Multivariable logistic and linear regression models were used to identify independent predictors of the presence and quantity of CAC, respectively. In multivariable logistic regression analyses, aPWV was associated with the presence of CAC (P=0.011) after adjustment for age, male sex, total cholesterol, high-density lipoprotein cholesterol, diabetes, history of smoking, systolic blood pressure, body mass index, and use of hypertension and statin medications. In multivariable linear regression analyses, aPWV was significantly associated with log(CAC +1) after adjustment for the covariates enumerated above (P<0.0001). aPWV remained significantly associated with both the presence and quantity of CAC even after the additional adjustment for diastolic blood pressure. We conclude that aPWV is related to subclinical coronary atherosclerosis independent of conventional risk factors (including indices of blood pressure) and may be a biomarker of cardiovascular risk in asymptomatic individuals.     

Aortic pulse pressure is associated with the localization of coronary artery disease based on coronary flow lateralization

BackgroundAortic pulse pressure (APP) is related to arterial stiffness and associated with the presence and extent of coronary artery disease (CAD). Besides, the left coronary artery (LCA) has a predominantly diastolic flow while the right coronary artery (RCA) receives systolic and diastolic flow. Thus, we hypothesized that increased systolic-diastolic pressure difference had a greater atherogenic effect on the RCA than on the LCA.MethodsA random sample of 433 CAD patients (145 females, 288 males, mean age 65.0 ± 11.1 years) undergoing coronary angiography at Staten Island University Hospital between January 2005 and May 2008 was studied. Coronary lesion was defined as a ≥50% luminal stenosis. Patients were divided into three groups, with isolated LCA lesions (n = 154), isolated RCA lesions (n = 36) or mixed LCA and RCA lesions (n = 243).ResultsAPP differed significantly between groups, being highest when the RCA alone was affected (67.6 ± 20.3 mm Hg for LCA vs. 78.8 ± 22.0 for RCA vs. 72.7 ± 22.6 for mixed, P = 0.008 for analysis of variance (ANOVA)). Age and gender were not associated with CAD location. Heart rate was associated with CAD location, lowest in RCA group, and negatively correlated with APP. However, left ventricular ejection fraction (LVEF) was lower in the mixed CAD group and positively correlated with APP. The association between APP and right-sided CAD persisted in multivariate logistic regression adjusting for confounders, including heart rate, LVEF and medication use. A similar but less significant pattern was seen with brachial arterial pressures.ConclusionsAortic pulse pressure may affect CAD along with coronary flow phasic patterns.American Journal of Hypertension 2012; doi:10.1038/ajh.2012.87.     

High blood pressure is inversely related with the presence and extent of coronary collaterals

Patients with hypertension have an increased case fatality during acute myocardial infarction (MI). Coronary collateral (CC) circulation has been proposed to reduce the risk of death during acute ischaemia. We determined whether and to which degree high blood pressure (BP) affects the presence and extent of CC circulation. A cross-sectional study in 237 patients (84% males), admitted for elective coronary angioplasty between January 1998 and July 2002, was conducted. Collaterals were graded with Rentrop's classification (grade 0-3). CC presence was defined as Rentrop-grade > or =1. BP was measured twice with an inflatable cuff manometer in seated position. Pulse pressure was calculated by systolic blood pressure (SBP)-diastolic blood pressure (DBP). Mean arterial pressure was calculated by DBP+1/3 x (SBP-DBP). Systolic hypertension was defined by a reading > or =140 mmHg. We used logistic regression with adjustment for putative confounders. SBP (odds ratio (OR) 0.86 per 10 mmHg; 95% confidence interval (CI) 0.73-1.00), DBP (OR 0.67 per 10 mmHg; 95% CI 0.49-0.93), mean arterial pressure (OR 0.73 per 10 mmHg; 95% CI 0.56-0.94), systolic hypertension (OR 0.49; 95% CI 0.26-0.94), and antihypertensive treatment (OR 0.53; 95% CI 0.27-1.02), each were inversely associated with the presence of CCs. Also, among patients with CCs, there was a graded, significant inverse relation between levels of SBP, levels of pulse pressure, and collateral extent. There is an inverse relationship between BP and the presence and extent of CC circulation in patients with ischaemic heart disease.     

High brachial-ankle pulse wave velocity is an independent predictor of the presence of coronary artery disease in men.

Pulse wave velocity (PWV) is an index of arterial stiffness, and a simple device for measuring brachial-ankle PWV (baPWV) has recently been developed. However, the clinical application of baPWV in patients with coronary artery disease (CAD) remains to be fully evaluated. This cross-sectional study was conducted to evaluate whether a higher baPWV predicts the presence of CAD. The baPWV was measured in 123 patients (77 males, 46 females; 63.5+/-11.8 years) who were undergoing coronary angiography. CAD was defined as >50% diameter stenosis. Hemodynamic data and cardiovascular risk factors were examined according to the presence or absence of CAD. Patients with CAD were significantly older across both sexes. The presence of hypertension and chest pain, but not baPWV, was correlated with CAD in females. The baPWV, and the presence of diabetes, hyperlipidemia, and chest pain were related to the presence of CAD in males. Multivariate logistic regression analysis in male patients showed that baPWV, diabetes, hyperlipidemia, and chest pain were independent risk factors for the presence of CAD. Furthermore, high baPWV in males with or without chest pain had a positive predictive value of 81.8% and 71.7% for the presence of CAD, respectively. In conclusion, high baPWV was shown to be a good independent predictor for the presence of CAD in men.     

Fractional diastolic and systolic pressure in the ascending aorta are related to the extent of coronary artery disease

BACKGROUND: Ascending aortic fractional pulse pressure and fractional systolic pressure (FSP) were demonstrated to differentiate patients with and without coronary artery disease. However, no study so far has analyzed the relationship between FSP and fractional diastolic pressure (FDP) and the extent of coronary artery disease. Therefore, we investigated the relationship between ascending aortic FSP and FDP and the extent of coronary atherosclerosis in unselected patients with angiographically confirmed coronary artery disease. METHODS: The study group consisted of 445 patients (350 men and 95 women, mean age 58.5 +/- 9.7 years) with angiographically confirmed coronary artery disease and ejection fraction > 55%. Invasive ascending aortic blood pressure during catheterization and conventional sphygmomanometer measurements were taken. RESULTS: Pulse pressure (PP), FSP, and FDP derived from intraaortic measurements differentiated patients with one-, two-, and three-vessel coronary artery disease (PP, 62.8 +/- 15.8 v 64.8 +/- 17.9 v 71.7 +/- 19.1 [P < .0001]; FSP, 1.45 +/- 0.09 v 1.46 +/- 0.10 v 1.51 +/- 0.12 [P < .0001]; FDP 0.77 +/- 0.05 v 0.77 +/- 0.05 v 0.75 +/-0.06 [P < .0001]). After multivariate stepwise adjustment, the odds ratio (OR) and confidence interval (CI) of having three-vessel disease was as follows: PP per 10 mm Hg, OR = 1.15, 95% CI = 1.01 to 1.30; FSP per 0.1, OR = 1.28, 95% CI = 1.03 to 1.60; and FDP per 0.1, OR = 0.61, 95% CI = 0.39 to 0.95. None of the brachial pressure indices was independently related to the extent of coronary atherosclerosis. CONCLUSIONS: Pulse pressure (PP), FSP, and FDP of the ascending aorta are related to the risk of three-vessel disease in patients with coronary artery disease and preserved left ventricular function.     

Endogenous oestradiol but not testosterone is related to coronary artery disease in men

Objectives Men die of coronary artery disease (CAD) more often than women. There is evidence that testosterone either is neutral or has a beneficial effect on male cardiovascular disease. The role of oestrogens in male CAD has been less studied. This study was carried out with the purpose of evaluating the relationship between sex hormone levels and CAD. Design Case–control study. Participants Men (aged 40–70) submitted to coronary angiography. A 70% occlusion of at least one major coronary artery defined the cases; subjects with ≤50% occlusion constituted the control group. Measurements Blood samples were collected for total testosterone (TT), oestradiol, luteinizing hormone, follicle‐stimulating hormone, sex hormone‐binding globulin, lipid profile and albumin measurements. Bioavailable and free testosterone, free androgen index (FAI) and free oestrogen index (FEI) were calculated. Oestradiol and TT levels were examined as terciles, based on the whole study population. Results Of the 140 patients included, 72 were cases and 68 were controls. The baseline characteristics of the two groups were similar, except for the older age and lower LDL‐C in the cases. Oestradiol and FEI but not total, bioavailable and free testosterone and FAI correlated positively with CAD. After adjustments for potential confounders, oestradiol remained statistically significant. The prevalence of CAD was significantly higher in the 3rd than in the 1st tercile of oestradiol. Conclusion In this study, men with CAD had higher oestradiol and FEI levels. Additional studies are needed to clarify the direction of causality and possible underlying mechanisms.     

Aortic pulse pressure and aortic pulsatility are associated with angiographic coronary artery disease in women

Background. Studies indicated that both aortic pulse pressure (PP) and aortic pulsatility are independently associated with angiographic coronary artery disease (CAD). However, most of these studies included a majority of male subjects, and women were underrepresented. Objective. We investigated the relation of aortic PP and aortic pulsatility derived from invasively measured ascending aortic pressure waveform and presence of angiographic CAD in women undergoing diagnostic coronary angiography. Methods and results. From September 2003 to April 2004, 262 unselected female subjects undergoing first cardiac catheterization were consecutively included in the study. Systolic, diastolic and mean pressure waveforms of the ascending aorta were measured during cardiac catheterization with a fluid-filled system. Aortic pulsatility was estimated as the ratio of aortic PP to mean pressure. Angiographic CAD was detected in 175 (67%) patients. In multiple-adjusted logistic regression, both aortic PP and aortic pulsatility were significantly associated with the presence of CAD (for a 10-mmHg increase in PP: odds ratio [OR] = 1.3, 95% confidence interval [CI] = 1.1-1.76; for a 0.1 increase in aortic pulsatility: OR = 1.8, 95% CI = 1.3-2.4). When patients were divided into tertiles according to the level of aortic pulsatility, it was noted that multiple-adjusted OR of presence CAD was 2.2 (95% CI = 1.1-4.4) for the middle tertile of the aortic pulsatility level and 5.9 (95% CI = 2.7-12.8) for the highest tertile of the aortic pulsatility level compared with the lowest tertile. Conclusion. In female subjects referred to coronary angiography, ascending aorta PP and aortic pulsatility are significantly associated with the presence of angiographic CAD and these associations are independent of age and other cardiovascular risk factors.     

微量尿蛋白与冠状动脉病变相关性研究

目的：分析微量尿蛋白与冠状动脉病变程度和范围的相关性。方法：入选连续179例冠状动脉造影患者,根据尿白蛋白肌酐比值(UACR)分为微量尿蛋白组(30～300μg/mg,n=43)和对照组(UACR＜30μg/mg,n=136)。比较两组冠状动脉造影结果差异,同时分析微量尿蛋白与冠状动脉病变之间的相关性。结果：与对照组相比,微量蛋白尿组高血压、糖尿病患者多见,且其造影阳性率(46．51%比30．15%,P＜0．05)、多支冠状动脉病变发病率(30．23%比8．82%,P<0．01)显著增高。结论：微量蛋白尿患者更易发生严重的冠状动脉病变。     

主动脉脉压与冠状动脉病变严重程度的相关性分析

目的探讨有创主动脉脉压（PP）水平与冠状动脉病变程度的关系。方法行冠状动脉造影术患者194（男103,女91）例;年龄（64±11）岁,造影同时测量主动脉血压。冠状动脉病变严重程度用冠状动脉病变支数及冠脉病变积分来表示。结果冠状动脉病变影响因素较多,如年龄、高血压史、糖尿病史、高血脂史等,其中冠脉狭窄组主动脉收缩压（SBP）、PP、脉压指数（PPI）显著高于非冠脉狭窄组,差异具统计学意义。其增高水平与冠脉狭窄程度呈线性关系。多因素回归分析显示:PP、年龄与冠脉狭窄程度密切相关。结论主动脉PP与冠脉病变严重程度相关,且可能是冠脉病变的独立危险因素。     

Relation of diagonal ear lobe crease to the presence, extent, and severity of coronary artery disease determined by coronary computed tomography angiography

Controversy exists concerning the relation between diagonal ear lobe crease (DELC) and coronary artery disease (CAD). We examined whether DELC is associated with CAD using coronary computed tomography (CT) angiography. We studied 430 consecutive patients without a history of coronary artery intervention who underwent CT angiography on a dual-source scanner. Presence of DELC was agreed by 2 blinded observers. Two blinded readers evaluated CT angiography images for presence of CAD and for significant CAD (≥50% stenosis). Chi-square and t tests were used to assess demographic differences between subgroups with and without DELC and the relation of DELC to 4 measurements of CAD: any CAD, significant CAD, multivessel disease (cutoff ≥2), and number of segments with plaque (cutoff ≥3). Multivariable logistic regression was performed to adjust for CAD confounders: age, gender, symptoms, and CAD risk factors. Mean age was 61 ± 13 and 61% were men. DELC was found in 71%, any CAD in 71%, and significant CAD in 17% of patients. After adjusting for confounders, DELC remained a significant predictor of all 4 measurements of CAD (odds ratio 1.8 to 3.3, p = 0.002 to 0.017). Sensitivity, specificity, and positive and negative predictive values for DELC in detecting any CAD were 78%, 43%, 77%, and 45%. Test accuracy was calculated at 67%. Area under the receiver operator characteristic curve was 61% (p = 0.001). In conclusion, in this study of patients imaged with CT angiography, finding DELC was independently and significantly associated with increased prevalence, extent, and severity of CAD.     

Factor VII levels in patients undergoing coronary angiography: factor VII and coronary artery disease

BACKGROUND: Factor VII (F VII) has been widely investigated as a risk factor for coronary atherosclerosis, however there is still debate about its role in the progression of coronary artery disease (CAD). In this study F VII levels were measured in patients with angiographically proven CAD and its relation with disease severity, coronary events and with other risk factors of coronary atherosclerosis were examined. METHODS: Consecutive patients referred to coronary angiography were divided in three groups: 1. CAD group--those with a significant lesion in one or more coronary arteries (n = 155), 2. High-risk group--patients with normal coronary arteries and with two or more risk factors (n = 54), 3. Controls--patients with normal coronary arteries and with no or one risk factor (n = 90). CAD group was also studied according to the number of vessels involved and to the history of coronary events. RESULTS: Mean F VII levels were not different between the three groups of patients. In CAD group, F VII increased parallel to the number of vessels involved (one vessel disease: 85 +/- 20%, two vessel disease: 92 +/- 23%, three vessel disease: 105 +/- 23%). Patients with a history of coronary events had significantly higher F VII levels than those without such a history (96 +/- 25% versus 89 +/- 22% respectively, P = 0.02). However, logistic regression analysis revealed no significant relation between F VII and either the presence of CAD or coronary events. CONCLUSIONS: F VII levels increase in patients with previous coronary events, but it is not an independent risk factor for the progression or for the severity of CAD.     

B-type natriuretic peptide and extent of lesion on coronary angiography in stable coronary artery disease

OBJECTIVE: Although it is well established that plasma B-type natriuretic peptide (BNP) levels are higher in patients with acute coronary syndromes, the relationship between plasma BNP level and stable coronary artery disease is not clear. The aim of this study was to examine the relationship between plasma BNP levels and the extent of obstructive lesions on coronary angiography in stable coronary artery patients. METHODS: Plasma BNP concentrations were measured in 62 patients with a diagnosis of stable angina pectoris who had a left ventricular ejection fraction (LVEF) >or=45% on echocardiographic evaluation. Coronary angiography was performed for all patients, who were than divided into two groups according to the results of the angiography. Group I consisted of the patients who had a lesion leading to an obstruction of the lumen in any coronary artery by less than 50% or those who had normal coronary arteries. All other patients constituted group II. RESULTS: In group I (n=26), the mean plasma BNP level was 64.8+/-29.5 pg/ml. In group II (n=36), it was 99.7+/-55.4 pg/ml. BNP was significantly higher in group II (P=0.007) than group I. The BNP concentration of the patients with one-vessel disease (n=12), two-vessel disease (n=16), and three-vessel disease (n=8) were 77.9+/-34.9 pg/ml, 109.3+/-67.9 pg/ml, 113.3+/-48.1 pg/ml consecutively. In this respect, the plasma BNP was significantly higher in the groups with more extended vessel disease (P=0.02). When we compared the patients according to involvement of left anterior descending artery (LAD), BNP levels were significantly higher in this group, (116.1+/-55.8 pg/ml versus 64.1+/-30.2 pg/ml; P=0.001). CONCLUSION: Plasma levels of BNP were higher in patients who have stable coronary artery disease with preserved left ventricular systolic function. The level of increase in plasma BNP concentration was positively correlated with the extent of lesion and LAD involvement on coronary angiography.     

Aortic atherosclerosis is a marker for significant coronary artery disease

Atherosclerosis is a generalized process that may involve the entire vasculature as well as the coronary arteries. Aortic atherosclerosis (AA) is associated with an increased risk for recurrent ischemic stroke and cardiovascular death and can be diagnosed by transesophageal echocardiography (TEE). We performed TEE in 60 patients (47 men and 13 women; age range 37-78, mean 53.5 +/- 9.9) who underwent coronary angiography, to assess whether atherosclerosis in the thoracic aorta correlates with coronary artery disease (CAD) or may be a marker for it. Significant CAD was defined as either > 50% reduction of internal diameter of the left main coronary artery or > 70% reduction of the internal diameter in the anterior descending, right coronary or circumflex artery. The number of diseased vessels was based on the Coronary Artery Surgery Study criteria. A grading system was used to detect AA. The thoracic aorta was considered to be normal and classified as grade I when the internal surface was smooth and without lumen irregularities or increased echo-intensity. Grade II changes consisted of increased echodensity of the intima without lumen irregularity or thickening. Grade III changes consisted of increased echodensity of intima with well defined atheroma extending < 3 mm in the aorta. Grade IV and V changes consisted of atheroma > 3 mm and protruding mobile plaques, respectively. Grades III-V were considered as AA. Twenty two of the 29 patients (75.9%) with CAD and 10 of the 31 patients (32.3%) without CAD had AA detected by TEE. There was a significant relationship between CAD and AA (r = 0.44, p < 0.001). The sensitivity and specificity of AA in detecting CAD were 75.9% and 67.7%, respectively. Our data suggest that AA is common in patients with significant CAD. Detection of AA by TEE may be a marker for CAD and early detection of aortic atherosclerosis may contribute to diagnostic and therapeutic interventions and thereby improve the prognosis.