Aortic atherosclerosis is a marker for significant coronary artery disease

Atherosclerosis is a generalized process that may involve the entire vascul ature as well as the coronary arteries. Aortic atherosclerosis (AA) is asso ciated with an increased risk for recurrent ischemic stroke and cardiovascu lar death and can be diagnosed by transesophageal echocardiography (TEE). W e 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 atheros clerosis in the thoracic aorta correlates with coronary artery disease (CAD ) or may be a marker for it. Significant CAD was defined as either > 50% re duction of internal diameter of the left main coronary artery or > 70% redu ction of the internal diameter in the anterior descending, right coronary o r circumflex artery. The number of diseased vessels was based on the Corona ry Artery Surgery Study criteria. A grading system was used to detect AA. T he thoracic aorta was considered to be normal and classified as grade I whe n the internal surface was smooth and without lumen irregularities or incre ased echo-intensity. Grade II changes consisted of increased echodensity of the intima without lumen irregularity or thickening. Grade LII changes con sisted of increased echodensity of intima with well defined atheroma extend ing < 3 mm in the aorta. Grade IV and V changes consisted of atheroma > 3 m m 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 pat ients (32.3%) without CAD had AA detected by TEE. There was a significant r elationship 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 atherosc lerosis may contribute to diagnostic and therapeutic interventions and ther eby improve the prognosis.