Tribouilloy C, Peltier M, Colas L, Rida Z, Rey J L, Lesbre J P
Department of Cardiology, South Hospital, University of Picardie, Amiens, France.
Eur Heart J. 1997 Sep;18(9):1478-83. doi: 10.1093/oxfordjournals.eurheartj.a015475.
This study was conducted to examine whether detection of atherosclerotic aortic plaque by multiplane transoesophageal echocardiography could predict the absence or presence of significant coronary artery disease in young and elderly valvular patients.
Clinical and angiographic features and transoesophageal echocardiography findings were prospectively analysed in 278 consecutive valvular patients. In 93 patients with significant coronary artery disease, 85 had thoracic aortic plaque on transoesophageal echocardiography studies. In contrast, aortic plaque existed in only 33 of the remaining 185 patients with normal or mildly abnormal coronary arteries. Therefore, the presence of aortic plaque on transoesophageal echocardiography studies had a sensitivity of 91%, a specificity of 82%, and positive and negative predictive values of 72% and 95%, respectively, for significant coronary artery disease. In the 109 patients aged > or = 70 years, these sensitivity, specificity, and positive and negative predictive values were 96%, 78%, 79%, and 96%, respectively. The above high negative predictive value was the major finding of this study and indicated that the absence of thoracic plaque is a strong predictor for absence of significant coronary artery disease. There was a significant relationship between the degree of aortic intimal changes and the severity of coronary artery disease (P < 0.0001). Multivariate logistic regression analysis revealed that aortic plaque, angina, hypercholesterolaemia and age were significant predictors of coronary artery disease: aortic plaque was the most significant independent predictor, even in patients > or = to 70 years.
This large prospective study indicates that examination of thoracic atherosclerotic plaque, by multiplane transoesophageal echocardiography, is a marker for coronary artery disease, and is a particularly powerful predictor for absence of significant coronary artery disease in valvular patients, even in the elderly.
本研究旨在探讨多平面经食管超声心动图检测动脉粥样硬化性主动脉斑块能否预测年轻及老年瓣膜病患者是否存在严重冠状动脉疾病。
对278例连续的瓣膜病患者进行了临床、血管造影特征及经食管超声心动图检查结果的前瞻性分析。在93例患有严重冠状动脉疾病的患者中，85例经食管超声心动图检查发现有胸主动脉斑块。相比之下，其余185例冠状动脉正常或轻度异常的患者中，只有33例存在主动脉斑块。因此，经食管超声心动图检查发现主动脉斑块对严重冠状动脉疾病的敏感性为91%，特异性为82%，阳性预测值和阴性预测值分别为72%和95%。在109例年龄≥70岁的患者中，这些敏感性、特异性、阳性预测值和阴性预测值分别为96%、78%、79%和96%。上述高阴性预测值是本研究的主要发现，表明胸主动脉斑块的缺失是严重冠状动脉疾病缺失的有力预测指标。主动脉内膜改变程度与冠状动脉疾病严重程度之间存在显著相关性（P<0.0001）。多因素逻辑回归分析显示，主动脉斑块、心绞痛、高胆固醇血症和年龄是冠状动脉疾病的重要预测因素：主动脉斑块是最显著的独立预测因素，即使在年龄≥70岁的患者中也是如此。
这项大型前瞻性研究表明，多平面经食管超声心动图检查胸主动脉粥样硬化斑块是冠状动脉疾病的一个标志物，对于瓣膜病患者，尤其是老年人，是严重冠状动脉疾病缺失的一个特别有力的预测指标。
