USE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY TO PREDICT SIGNIFICANT CORONARY-ARTERY DISEASE IN AORTIC-STENOSIS

Study objectives: This study was conducted to examine if the use of mu ltiplane transesophageal echocardiography (TEE) could predict the abse nce or the presence of significant coronary artery disease (CAD) in pa tients with aortic stenosis. Design: Prospective study. Setting: Unive rsity hospital. Patients: Clinical, angiographic features and TEE find ings were prospectively analyzed in 132 consecutive patients with aort ic stenosis. Measurements and results: In 63 patients with significant CAD, 57 had thoracic aortic plaque on TEE studies. In contrast, aorti c plaque existed in only 19 of the remaining 69 patients with normal o r mildly abnormal coronary arteries. Therefore, the presence of aortic plaque on the TEE identified significant CAD with a sensitivity of 90 .5%, a specificity of 72.5%, and with positive and negative predictive values of 75.0% and 89.3%, respectively. There was a significant rela tion between the severity of thoracic aortic atherosclerosis and the s everity of CAD (p<0.0001). Multivariate logistic regression analysis r evealed that aortic plaque, angina, and age were independent predictor s of CAD. Aortic plaque was the most significant independent predictor . Conclusion: This prospective study indicates that TEE examination of thoracic atherosclerotic plaque is a powerful predictor of absence of significant CAD in patients with aortic stenosis.