Thoracic aortic atheroma severity predicts high-risk coronary anatomy in patients undergoing transesophageal echocardiography

Xuedong Shen, Wilbert S. Aronow, Chandra K. Nair, Hema Korlakunta, Mark Jeffrey Holmberg, Fenwei Wang, Stephanie Maciejewski, Dennis J. Esterbrooks

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Abstract

Introduction: We hypothesized a relationship between severity of thoracic aortic atheroma (AA) and prevalence of high-risk coronary anatomy (HRCA). Material and methods: We investigated AA diagnosed by transesophageal echocardiography and HRCA diagnosed by coronary angiography in 187 patients. HRCA was defined as ≥ 50% stenosis of the left main coronary artery or significant 3-vessel coronary artery disease (≥ 70% narrowing). Results: HRCA was present in 45 of 187 patients (24%). AA severity was grade I in 55 patients (29%), grade II in 71 patients (38%), grade III in 52 patients (28%), grade IV in 5 patients (3%), and grade V in 4 patients (2%). The area under receiver operating characteristic curve for AA grade predicting HRCA was 0.83 (p = 0.0001). The cut-off points of AA to predict HRCA was > II grade. The sensitivity and specificity of AA > grade II to predict HRCA were 76% and 81%, respectively. After adjustment for 10 variables with significant differences by univariate regression, AA > grade II was related to HRCA by multivariate regression (odds ratio = 7.5, p <0.0001). During 41-month follow-up, 15 of 61 patients (25%) with AA >grade II and 10 of 126 patients (8%) with AA grade ≤ 2 died (p = 0.004). Survival by Kaplan-Meier plot in patients with AA > grade II was significantly decreased compared to patients with AA ≤ grade II (p = 0.002). Conclusions: AA > grade II is associated with a 7.5 times increase in HRCA and with a significant reduction in all-cause mortality.

Original languageEnglish
Pages (from-to)61-66
Number of pages6
JournalArchives of Medical Science
Volume7
Issue number1
DOIs
StatePublished - Feb 2011

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Transesophageal Echocardiography
Atherosclerotic Plaques
Anatomy
Thorax
Coronary Angiography
ROC Curve
Coronary Artery Disease
Coronary Vessels
Pathologic Constriction
Odds Ratio
Sensitivity and Specificity

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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Thoracic aortic atheroma severity predicts high-risk coronary anatomy in patients undergoing transesophageal echocardiography. / Shen, Xuedong; Aronow, Wilbert S.; Nair, Chandra K.; Korlakunta, Hema; Holmberg, Mark Jeffrey; Wang, Fenwei; Maciejewski, Stephanie; Esterbrooks, Dennis J.

In: Archives of Medical Science, Vol. 7, No. 1, 02.2011, p. 61-66.

Research output: Contribution to journalArticle

Shen, Xuedong ; Aronow, Wilbert S. ; Nair, Chandra K. ; Korlakunta, Hema ; Holmberg, Mark Jeffrey ; Wang, Fenwei ; Maciejewski, Stephanie ; Esterbrooks, Dennis J. / Thoracic aortic atheroma severity predicts high-risk coronary anatomy in patients undergoing transesophageal echocardiography. In: Archives of Medical Science. 2011 ; Vol. 7, No. 1. pp. 61-66.
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abstract = "Introduction: We hypothesized a relationship between severity of thoracic aortic atheroma (AA) and prevalence of high-risk coronary anatomy (HRCA). Material and methods: We investigated AA diagnosed by transesophageal echocardiography and HRCA diagnosed by coronary angiography in 187 patients. HRCA was defined as ≥ 50{\%} stenosis of the left main coronary artery or significant 3-vessel coronary artery disease (≥ 70{\%} narrowing). Results: HRCA was present in 45 of 187 patients (24{\%}). AA severity was grade I in 55 patients (29{\%}), grade II in 71 patients (38{\%}), grade III in 52 patients (28{\%}), grade IV in 5 patients (3{\%}), and grade V in 4 patients (2{\%}). The area under receiver operating characteristic curve for AA grade predicting HRCA was 0.83 (p = 0.0001). The cut-off points of AA to predict HRCA was > II grade. The sensitivity and specificity of AA > grade II to predict HRCA were 76{\%} and 81{\%}, respectively. After adjustment for 10 variables with significant differences by univariate regression, AA > grade II was related to HRCA by multivariate regression (odds ratio = 7.5, p <0.0001). During 41-month follow-up, 15 of 61 patients (25{\%}) with AA >grade II and 10 of 126 patients (8{\%}) with AA grade ≤ 2 died (p = 0.004). Survival by Kaplan-Meier plot in patients with AA > grade II was significantly decreased compared to patients with AA ≤ grade II (p = 0.002). Conclusions: AA > grade II is associated with a 7.5 times increase in HRCA and with a significant reduction in all-cause mortality.",
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