Aortic atheroma is not a sensitive marker for coronary artery disease in patients with mitral valve disease.

Aortic atheroma detected by transoesophageal echocardiography has been repo rted to be a good prognostic marker for coronary disease on angiography. Th e value of this detection in valvular heart disease would be to avoid preop erative coronary angiography in asymptomatic patients. The aim of this stud y was to assess the prognostic value of aortic atheroma in a population wit h a low prevalence of coronary artery disease in whom transoesophageal echo cardiography was systematically performed. In addition, calcification of th e aortic knuckle, a marker of atherosclerosis, was analysed by simple chest X-ray. One hundred and ninety two patients (103 men, 89 women; mean age: 63.1 +/- 15 years), operated for mitral valve replacement, underwent transoesophagea l echocardiography, angiography, within 6 months, and chest X-ray. The cardiovascular risk factors, presence of aortic atherome, angiographic coronary artery disease and aortic calcification were studied. Aortic atheroma was observed in 72 patients (37.5%), usually in the descend ing thoracic aorta (73.6%). Coronary stenosis was observed in 36 patients ( 18.7%). On univariate analysis, aortic atheroma predicted coronary stenosis with a sensitivity of 53%, specificity of 66% and positive predictive value of 26% and negative predictive value of 86%, compared with chest X-ray: 71%, 65%, 33% and 90%, respectively. In multivariate analysis, only hypercholesterolaemia, smoking and age predi cted the presence of coronary artery disease. The presence of aortic athero ma was not predictive (p = 0.3). The authors conclude that aortic atheroma does not predict the presence of coronary artery disease in a patient population with mitral valve disease a nd a low prevalence of coronary artery disease. Simple chest X-ray has almo st the same diagnostic value. The association of these two investigations d oes not give sufficient negative predictive values to avoid coronary angiog raphy.