Transesophageal echocardiographic detection of thoracic aortic plaque could noninvasively predict significant obstructive coronary artery disease

OBJECTIVE: Previous pathologic and roentgenographic studies have suggested a relation between aortic plaque and coronary artery disease but have lacked clinical utility. The study was undertaken to elucidate whether atherosclerotic aortic plaque detected by transesophageal echocardiography can be a clinically useful marker for significant obstructive coronary artery disease. METHODS: Clinical and angiographic features and intraoperative transesophageal echocardiographic findings were prospectively analyzed in 131 consecutive patients (58 women and 73 men, aged 17 to 75 years [mean 54 +/- 12]) undergoing open heart surgery. Significant obstructive coronary artery disease was defined as > or = 50% stenosis of > or = 1 major branch. RESULTS: Seventy-six (58%) of 131 patients were found to have obstructive coronary artery disease. In 76 patients with significant coronary artery disease, 71 had thoracic aortic plaque. In contrast, aortic plaque existed in only 10 of the remaining 55 patients with normal or minimally abnormal coronary arteries. The presence of aortic plaque on transesophageal echocardiographic studies had a sensitivity of 93%, a specificity of 82% and positive and negative predictive values of 88% and 90%, respectively, for significant coronary artery disease. There was a significant relationship between the degree of aortic intimal changes and the severity of coronary artery disease (r = 0.74, P < 0.0001). Multivariate logistic regression analysis of patient age, sex, risk factors of cardiovascular disease and transesophageal, echocardiographic findings revealed that atherosclerotic aortic plaque was the most significant independent predictor of coronary artery disease. CONCLUSION: This study indicates that transesophageal echocardiographic detection of atherosclerotic plaque in the thoracic aorta is useful in the noninvasive prediction of the presence and severity of coronary artery disease.

Comparison between Mitral Flow and Mitral Annulus Velocity by Doppler Tissue Imaging according to Increment of Heart Rate

BACKGROUND AND OBJECTIVES: The utility of Doppler mitral flow pattems for the indirect assessment of left ventricular diastolic function is valid and widely used. One of the most common variables affecting mitral flow is heart rate. The aim of this study was to compare between mitral flow and mitral annulus velocity by Doppler tissue imaging (DTI) according to increment of heart rate. MATERIALS AND METHODS: 17 healthy volunteers (M: F=10: 7, mean age 27+/-2 years) comprised this study. They were free of any acute or chronic illness. The heart rate was elevated by increments of 10 beats (baseline, 80, 90, 100, 110, 120) by transesophageal atrial pacing. We measured mitral flow parameters (E and A velocity, E/A ratio, IVRT, DT of E) and mitral annulus velocity by DTI (e and a velocity, e/a ratio, RIVRT). We gave the score of visual estimation at baseline and each heart rate. The definition of the score was as follows, 1: well visualization of each envelope 2: summation of velocity wave forms 3: no differentiation, completely fused. RESULTS: 1) The E of mitral flow was significantly increased from 100 to 120 BPM and A velocity was significantly increased from 80 to 100 BPM (p<0.05). E/A ratio was significantly decreased from 90 to 100 BPM than baseline (p<0.05). 2) The e and e/a ratio of mitral annulus velocity were significantly increased from above 110, 100 BPM than baseline, respectively (p<0.05). But a velocity was little changed. 3) The score was all significantly higher in mitral annulus velocity pattern by DTI than mitral flow at each heart rate. CONCLUSIONS: The mitral annulus velocity by DTI is less affected by heart rate and visualized better than mitral fiow in increased heart rate. Therefore the assessment of mitral annulus velocity may be helpful for evaluating diastolic function during heart rates of physiologic range.

Persistent Left Superior Vena Cava Diagnosed by Contrast Transthoracic Echocardiography in Patient with Chronic Atrial Fibrillation

Presence of persistent left superior vena cava(PLSVC) is considered to be one of the most frequently encountered anomalies of the systemic venous return. The incidence of PLSVC is reported to be 0.3% to 0.5% in the general population, and in 3% to 10% of patients with congenital heart disease. The presence of PLSVC draining into the coronary sinus is of no hemodynamic significance. However, it is important to recognize this condition, as it can have important clinical implications. The diagnosis can be established by two demensional echocardiography. It should be suspected by the presence of dilated coronary sinus, and confirmed by contrast echocardiography. A 61-year-old man with chronic atrial fibrillation was diagnosed as PLSVC by contrast transthoracic echocardiography(TTE) using agitated saline. Contrast TTE allowed visualization of the time sequence of the echo-contrast within the right atrium first following injection of right antecubital vein. Following injection of left antecubital vein, opacification of the dilated coronary sinus first and then the right atrium was seen.