Key Points
- To examine whether multiplane transoesophageal echocardiography detection of thoracic aortic plaque can accurately predict the presence or absence of significant coronary artery disease in valvular patients.
- Prospectively evaluated clinical features, coronary angiograms, and multiplane transoesophageal echocardiography findings in 278 consecutive valvular patients, including 109 patients aged ≥70 years.
- Determined diagnostic performance (sensitivity, specificity, positive predictive value, negative predictive value) and performed multivariate logistic regression analysis to identify independent predictors of coronary artery disease.
- Aortic plaque was detected in 85 of 93 patients with coronary artery disease and in 33 of 185 patients without significant disease, yielding an overall sensitivity of 91%, specificity of 82%, positive predictive value of 72%, and negative predictive value of 95%.
- In patients aged ≥70 years (n=109), plaque detection demonstrated a sensitivity of 96%, specificity of 78%, positive predictive value of 79%, and negative predictive value of 96%.
- Aortic intimal changes significantly correlated with coronary disease severity (P < 0.0001), and aortic plaque served as the strongest independent predictor of coronary artery disease on multivariate logistic regression alongside angina, hypercholesterolaemia, and age.
Structured PICO
Does the absence of thoracic aortic plaque on multiplane transoesophageal echocardiography predict the absence of significant coronary artery disease in valvular patients?
PPopulation278 consecutive valvular patients, including 109 patients aged ≥ 70 years
IInterventionMultiplane transoesophageal echocardiography (TEE) for the detection of thoracic atherosclerotic aortic plaque
OOutcomePresence or absence of significant coronary artery disease (assessed by angiography)surrogate
The absence of thoracic aortic plaque on multiplane transoesophageal echocardiography is a powerful negative predictor for significant coronary artery disease in valvular patients, including the elderly.