Jang Seong Chae

Transesophageal Echocardiographic Detection of Thoracic Aortic Plaque Could Noninvasively Predict Significant Obstructive Coronary Artery Disease

Objective Previous pathologic and roentgenographic studies have suggested a relation between aortic plaque and coronary artery disease but have lacked clinical utility. The study was undertaken to elucidate whether atherosclerotic aortic plaque detected by transesophageal echocardiography can be a clinically useful marker for significant obstructive coronary artery disease. Methods Clinical and angiographic features and intraoperative transesophageal echocardiographic findings were prospectively analyzed in 131 consecutive patients (58 women and 73 men, aged 17 to 75 years [mean 54±12]) undergoing open heart surgery. Significant obstructive coronary artery disease was defined as > or = 50% stenosis of > or = 1 major branch. Results Seventy-six (58%) of 131 patients were found to have obstructive coronary artery disease. In 76 patients with significant coronary artery disease, 71 had thoracic aortic plaque. In contrast, aortic plaque existed in only 10 of the remaining 55 patients with normal or minimally abnormal coronary arteries. The presence of aortic plaque on transesophageal echocardiographic studies had a sensitivity of 93%, a specificity of 82% and positive and negative predictive values of 88% and 90%, respectively, for significant coronary artery disease. There was a significant relationship between the degree of aortic intimal changes and the severity of coronary artery disease (r=0.74, P<0.0001). Multivariate logistic regression analysis of patient age, sex, risk factors of cardiovascular disease and transesophageal echocardiographic findings revealed that atherosclerotic aortic plaque was the most significant independent predictor of coronary artery disease. Conclusion This study indicates that transesophageal echocardiographic detection of atherosclerotic plaque in the thoracic aorta is useful in the noninvasive prediction of the presence and severity of coronary artery disease.

Amyloidosis With Cardiac Involvement

A 59-year-old woman was admitted because of lethargy. She had been treated for heart failure for 5 years before admission, which progressed to include lower-extremity edema as well as orthopnea and nocturnal dyspnea. The serial ECGs and echocardiographic findings are summarized in Figs 1⇓ and 2⇓. Forearm skin, rectal (Fig 3⇓), and endomyocardial biopsies (Fig 4⇓) were performed. On the basis of our findings (Figs …