Predictive value of aortic atherosclerosis detected by transoesophageal echocardiography for the presumption of coronary artery disease

The aim of this study was to determine the relationship between plaques of aortic atheroma detected by transoesophageal echocardiography and the condition of the coronary arteries at coronary angiography. Two hundred and seventeen consecutive patients were included for systematic transoesophageal echocardiography blinded to the results of coronary angiography. Significant coronary disease was defined as stenosis of at least 70% of the artery lumen. Aortic atherosclerosis was classified in four grades. The average age of the patients was 54.5 +/- 10.5 years. The sex ratio was 2.55 in favour of men. The average coronary score was 5 +/- 4.5 and the lesion index was 1.1 +/- 0.96. One hundred and fifty-nine patients had aortic atheroma, 73% of which (80 cases) were complex lesions. The descending aorta was the commonest site (91%) followed by the transverse (40% and ascending aorta (14%). When the ascending aorta was affected there was a very significant association with coronary artery disease (100% of cases). Sixty-one per cent of patients had lesions of one aortic segment, 28% had lesions of two aortic segments and in 10%, all three aortic segments were involved. The presence of aortic atheroma was correlated with coronary artery disease with a sensitivity and specificity of 86% and 76% respectively. The positive and negative predictive values were 81% and 31% respectively. Seventy-five per cent of patients with a coronary score of at least 7 had aortic atheroma with complex lesions in 47% of cases. The lesion index was significantly higher in this group when the coronary score was less than 7 (1.98 +/- 0.8 vs 0.65 +/- 0.7, p<0.00001). Patients with coronary artery disease have more complex lesions of the descending than of the ascending aorta (94 vs 25%). Significant coronary artery disease was correlated with the presence of aortic atheroma, especially of the ascending aorta. The specificity and positive predictive values were 100% but the negative predictive value was poor, irrespective of the aortic segment involved (32% for the ascending aorta, 36% for the transverse and 35% for the descending aorta). The authors conclude that transoesophageal echocardiography of the thoracic aorta is a good method of predicting severe coronary atherosclerotic disease.