Thoracic aortic atherosclerosis: the diagnostic approach and the predictive value for coronary artery disease

ABSTRACT

This work was planned to study the validity of transesophageal echocadiography [TEE], in diagnosis of aortic atherosclerosis, and its predictive value for coronary artery disease. 160 patients refered for coronary angiography were subjected to thorough clinical examination, biochemical studies [blood sugar and lipid profile], transthoracic echo-Doppler study, coronary angiography and transesophageal echocardiography [TEE] to assess aortic atherosclerosis.The patients were classified into two main groups according to angiographic results. I included 38 patients with normal angiography. II included 122 with abnormal angiography.Out of the 38 patients with normal angiography, only 4 [10.5%] showed TEE evidence of thoracic aortic atherosclerosis.Aortic intimal medial thickness [AoIMT] > 3 mm, whereas out of 122 with CAD, the percentage of aortic atherosclerosis was [93.4%] P < 0.0001. The grade of atherosclerotic aortic lesions correlated positively with extent of CAD, where as the AoIMT increase, the number of diseased vessels increased. The results showed that the validity of aortic atherosclerosis in prediction of CAD was sensitivity [93.4%], specificity [89.5%], positive predictive value [96.6%] and the negative predictive value [80.9%]. The regional wall motion abnormality score and index were significantly increased as the AoIMT increase [P<0.01]. It was concluded that the TEE detection of thoracic aortic atherosclerosis is a very good predictive for CAD, with high positive and negative predictive values. AolMT and atherosclerotic plaques could be considered an independent risk predictor for CAD. So TEE should be planned for screening of aortic atherosclerosis in high risk groups to detect subclinical disease, for patients subjected to CABG and for elderly patients subjected to valve surgery to avoid embolic manifestation