Key result
Plaque in the ascending aorta detected by transesophageal echocardiography significantly predicted the presence of significant coronary artery disease (OR 2.51).
Why the study?
Given tremendous improvements in imaging quality over recent decades, the authors hypothesized that high-end ultrasound systems allow accurate prediction of the presence or absence of CAD.
Do transesophageal echocardiography signs of atherosclerosis (aortic plaque, mitral annular calcification, aortic stenosis) predict the presence of significant coronary artery disease?
Cohort (n=242)
No
Do transesophageal echocardiography signs of atherosclerosis (aortic plaque, mitral annular calcification, aortic stenosis) predict the presence of significant coronary artery disease?
The absence of mitral annular calcification, aortic stenosis, and aortic plaque on transesophageal echocardiography has an 80% negative predictive value for significant coronary artery disease, potentially aiding in ruling out CAD.
BACKGROUND: The accuracy of ultrasound signs as predictors for the presence of coronary artery disease (CAD) has been evaluated extensively in the 1990s and 2000s. Imaging quality has improved tremendously over the last decades. HYPOTHESIS: High-end ultrasound systems allow for accurate prediction of the presence or absence of CAD. METHODS: All patients who underwent a transesophageal echocardiography examination (TEE) between 2007 and 2016 and who had coronary angiography within 24 months before or after the TEE were retrospectively evaluated. RESULTS: A total of 242 patients fulfilled the inclusion criteria, 60% were male. Mean age was 70 years (SD ± 13 years). In multivariate regression analysis, plaque in the ascending aorta (odds ratio [OR] 2.51, 95% confidence interval [CI] 1.18-5.32, p = 0.017), plaque in at least one of the thoracic aortic segments (OR 2.07, 95% CI 1.02-4.22, p = 0.045), and the presence of mitral annular calcification (MAC, OR 1.84, 95% CI 1.01-3.36, p = 0.046) were predictors of significant CAD. The isolated finding of aortic stenosis (AS) (OR 2.53, 95%CI 1.23-5.21, p = 0.012) was a significant predictor for the absence of normal coronary arteries. CONCLUSION: With an negative predictive value (NPV) of 80%, the absence of MAC, AS, and aortic plaque makes the presence of significant CAD unlikely. If at least mild AS is present, normal coronary arteries are improbable.
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Schneider et al. (2020) conducted a cohort in Coronary artery disease (n=242). Plaque in the ascending aorta vs. Absence of plaque in the ascending aorta was evaluated on Presence of significant coronary artery disease (OR 2.51, 95% CI 1.18-5.32, p=0.017). Plaque in the ascending aorta detected by transesophageal echocardiography significantly predicted the presence of significant coronary artery disease (OR 2.51).
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