Atherosclerotic Aortic Plaque Detected byTransesophageal Echocardiography" ItsSignificance andLimitation as a Marker for Coronary Artery Disease intheElderly

Objectives: To elucidate whether atherosclerotic aorticplaque detected bytransesophageal echocardiography can beaclinically useful marker forcoronary artery disease intheelderly. Background: Atherosclerotic aortic plaque detected bytransesophageal echocardiography has beenreported tobea markerforcoronary artery disease. Itssignificance maybeimportant particularly intheelderly population, although toour knowledge, there are no datayet available. Methods: We performed transesophageal echocardiography on 84patients whohadpreviously undergone coronary arteriography. Thecriteria usedtodiagnose atherosclerotic plaque on transesophageal echocardiography were thepresence offocally orlinearly increased echodensity oftheaortic intima withlumenirregularity andthickening or ulceration. Results: Significant coronary artery disease (^50%stenosis) was detected inatleast one major coronary artery in27ofthe84patients. Aorticplaques were detected bytransesophageal echocardiography in25ofthe27patients (93%) withcoronary artery disease andin30of57 patients (53%) without coronary disease (p<0.001). Among 24patients 70years or older, aortic plaques were present in13of14(93%) patients withcoronary artery disease and9of10patients (90%) without coronary disease. Among 60patients younger than70years, aortic plaques were present in12of13patients (92%) withcoronary artery disease and21of47patients (45%) without coronary disease (p<0.01). Theindependent association between coronary artery disease andthepresence ofaortic plaque, age,gender, andother coronary risk factors was examined by multiple logistic regression analysis. Inpatients 70years or older, thepresence ofaortic plaque failed tobeapredictor ofsignificant coronary artery disease, although itwas indeed a strong predictor ofcoronary artery disease inpatients younger than70years(p<0.05). Conclusions: Inelderly patients, atherosclerotic aorticplaque detected bytransesophageal echocardiography isnotuseful inpredicting significant coronary artery disease. Itisuseful only inarelatively younger population.(CHEST 1997; 112:81-86)