901-109 Value of Visualizing Atherosclerotic Plaques on the Thoracic Aorta by Transesophageal Echocardiography in Conjunction with Pharmacologic Stress

Detection of atherosclerotic plaques within the thoracic aorta (TA) by transesophageal echocardiography(TEE) has been shown to be a useful marker to detect coronary artery disease (CAD). Dobutamine (Dob) stress echocardiography can induce segmental wall motion abnormalities (SWMA) in the presence of CAD. To determine the value of visualizing atherosclerotic plaques on the TA in conjunction with Dob-TEE, 60 pts (54 males, 6 females; mean age 59±13 yrs) with chest pain syndrome were studied. All pts underwent coronary angiography. Dob was infused in 3-min increments from 5 to 40 mcg/kg/min, Dob-TEE was considered positive if new or worsening of previously present SWMA were noted. Atherosclerotic plaques visualized on TA were divided into simple and complex lesions. Simple lesions were defined as intimal thickening or luminal irregularities, and complex lesions were protruding, ulcerated or mobile plaques noted.ResultsSignificant CAD (≥50% stenosis) was present in 49 pts and 11 pts had normal or non-significant disease. Sensitivity (SE), specificity (SP), positive (+PV), negative (-PV) predictive values, and diagnostic accuracy (DA) are:SESP+PV-PVDADob-TEE94%73%94%73%90%TA-TEE90%80%93%73%88%The TA showed atherosclerotic plaques in 45 of 49 pts with positive DobTEE and it was free of disease in 9 of 11 pts with negative Dob-TEE (90% agreement). The presence of complex lesions was significantly higher in pts with multivessel disease (MVD) (21 of 32 pts 66%) than in those with single vessel disease (SVD) (3 of 17 pts 18%), p<0.01. While simple lesions were more common in SVD (11 of 17 pts 65%) than in MVD (9 of 32 pts 28%), p<0.01. In conclusion, TA-TEE and Dob-TEE highly concur in detecting CAD. Visualization of complex lesions on TA-TEE before Dob-TEE should alert for the possibility of MVD