الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
SUMMARY
The purpose of this study was to determine whether TEE detection of thoracic aortic plaque could identify the presence and severity of coronary artery disease defined by angiography and to evaluate the usefulness of TEE in assessing the coronary artery tree in patients with coronary artery disease in relation to coronary
angiography.
For this purpose, clinical, angiographic features and transesophageal echocardiographic findings were analyzed in 52 patients in whom coronary angiography was indicated for evaluation of coronary artery disease. They were 34 men and 18 women aged 38 to 66 years with a mean of 47.8 ± 6.2 year.
Coronary angiography revealed significant coronary artery disease in 31 patient ”group A”. The remaining 21 patients were found to have normal coronary angiography or minimal. non-obstructive coronary artery disease (group B). in group A, 27 (87.2%) patients were found to have aortic plaque on TEE while in group B only 3 (14.3%) patients were found to have aortic plaque. Aortic plaque was a predictor of CAD at a static” cally high significant level (P<0.01). The presence of aortic plaque on TEE-examination in this study had a sensitivity of 87.’ % and a specificity of 85.7% for angiographically proved CAD. In our
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study, there was a significant relation between the presence aortic plaque and severity of CAD. Aortic plaques were found in all patibnts with two-vessel and three-vessel disease and in 78.9 percent of patients with single-vessel disease. On the other hand, the absence of atherosclerotic aortic plaques in patients with coronary artery disease were indicative of a decreased severity of CAD, where the 4 patients with obstructive coronary artery disease who did not have aortic plaques (False negative TEE) were found to have single-vessel disease. False negative transesophageal echocardiograms did not occur in the patients with more severe coronary artery disease. Also, the current study revealed a
significant relation between the degree of initmal changes in the
thoracic aorta and the incidence and severity of CAD. It was noted
that no patient with grade IV changes had normal coronary
angiogram.
Evaluation of the proximal coronary arteries by TEE showed that visualization of the LMCA was possible in all cases, while in case of LAD, LCX and RCA it was possible in 51.9%, 51.9% and 48.1% of patients respectively. The sensitivity and specificity of TEE in identifying stenosis of LMA, LAD, LCx and RCA were 100% and 100%, 73.3% and 100%, 30% and 100%,.42.9% and 100% respectively. Thus the. accuracy of TEE in identifying
proximal coronary stenosis varies from segment to segment and is
higher for the left main and left anterior descending coronary arteries.
Although the relation between coronary risk factors and CAD and aortic atherosclerosis was not the primary objective of our study; male sex, age, hypertension, hypercholesterolemia and smoking were found to have a significant relation to CAD. However, multivariate regression analysis revealed aortic plaque, smoking, and hypertension as independent predictors of CAD. Aortic plaque was the most significant independent predictor of CAD.
On the other hand, only male sex, hypercholesterolemia and smoking were statistically significant risk factors for atherosclerotic aortic plaque.