Predicting the presence of coronary artery disease by transesophageal echocardiography
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Wien Klin Wochenschr https://doi.org/10.1007/s00508-020-01686-x
Predicting the presence of coronary artery disease by transesophageal echocardiography Matthias Schneider Georg Goliasch
· Houtan Heidari · Hong Ran · Christian Roth · Christian Hengstenberg · Thomas Binder ·
Received: 20 November 2019 / Accepted: 21 May 2020 © The Author(s) 2020
Summary 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
M. Schneider, MD () · H. Heidari, MD · C. Roth, MD · C. Hengstenberg, MD · T. Binder, MD · G. Goliasch, MD, PhD Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18–20, 1090 Vienna, Austria [email protected] H. Ran, MD Department of Echocardiography, Nanjing First Hospital Affiliated to Nanjing Medical University, Nanjing, China
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least mild AS is present, normal coronary arteries are improbable. Keywords TEE · Aorta · Aortic plaque · Mitral annular calcification · Aortic stenosis
Introduction The accuracy of ultrasound signs as predictors for the presence of coronary artery disease (CAD) has been evaluated extensively in the 1990s and early 2000s. Imaging quality has changed tremendously since. The data used for earlier analyses were based on ultrasound images, which do not compare to today’s imaging systems, some of the earlier studies on mitral annular calcification (MAC) being based on M-mode findings [1–3]. Of the patients with peripheral arterial disease 41% have concomitant coronary or cerebrovascular disease [4]. In the Framingham study the presence of MAC predicted all cause death, cardiovascular death, and cardiovascular disease [5]. The presence of MAC was an independent predictor of cardiovascular events in another study, the risk being directly related to severity of MAC [6].
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