MULTIPLANE TRANSESOPHAGEAL ECHOCARDIOGRAPHIC ABSENCE OF THORACIC AORTIC PLAQUE IS A POWERFUL PREDICTOR FOR ABSENCE OF SIGNIFICANT CORONARY-ARTERY DISEASE IN VALVULAR PATIENTS, EVEN IN THE ELDERLY - A LARGE PROSPECTIVE-STUDY

Aims This study was conducted to examine whether detection of atherosc lerotic aortic plaque by multiplane transoesophageal echocardiography could predict the absence or presence of significant coronary artery d isease in young and elderly valvular patients. Methods and results Cli nical and angiographic features and transoesophageal echocardiography findings were prospectively analysed in 278 consecutive valvular patie nts. In 93 patients with significant coronary artery disease, 85 had t horacic aortic plaque on transoesophageal echocardiography studies. In contrast, aortic plaque existed in only 33 of the remaining 185 patie nts with normal or mildly abnormal coronary arteries. Therefore, the p resence of aortic plaque on transoesophageal echocardiography studies had a sensitivity of 91%, a specificity of 82%, and positive and negat ive predictive values of 72% and 95%, respectively, for significant co ronary artery disease. In the 109 patients aged greater than or equal to 70 years, these sensitivity, specificity, and positive and negative predictive values were 96%, 78%, 79%, and 96%, respectively. The abov e high negative predictive value was the major finding of this study a nd indicated that the absence of thoracic plaque is a strong predictor for absence of significant coronary artery disease, There was a signi ficant relationship between the degree of aortic intimal changes and t he severity of coronary artery disease (P<0.0001). Multivariate logist ic regression analysis revealed that aortic plaque, angina, hyperchole sterolaemia and age were significant predictors of coronary artery dis ease: aortic plaque was the most significant independent predictor, ev en in patients greater than or equal to 70 years. Conclusion This larg e prospective study indicates that examination of thoracic atheroscler otic plaque, by multiplane transoesophageal echocardiography, is a mar ker for coronary artery disease, and is a particularly powerful predic tor for absence of significant coronary artery disease in valvular pat ients, even in the elderly.