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[Aortic atheroma: not a sensitive indicators for coronary artery disease in patients with mitral valve disease]

M Marazanof1, F Thiessard, P Laffort

  • 1Service d'information médicale, hôpital Pellegrin, place Amélie-Raba-Léon, 33 000 Bordeaux.

Archives Des Maladies Du Coeur Et Des Vaisseaux
|August 2, 2001
PubMed

Insights

Aortic atheroma detected via transesophageal echocardiography does not reliably predict coronary artery disease in patients with mitral valve disease. Simple chest X-rays offer similar, insufficient predictive value to avoid coronary angiography.

Area of Science:

  • Cardiology
  • Diagnostic Imaging
  • Vascular Medicine

Context:

  • Aortic atheroma is a potential marker for coronary artery disease (CAD).
  • Transesophageal echocardiography (TEE) is used to detect aortic atheroma.
  • The utility of TEE in identifying CAD risk in valvular heart disease patients is under investigation.

Purpose:

  • To evaluate the prognostic value of aortic atheroma in predicting coronary artery disease (CAD) in patients with mitral valve disease and low CAD prevalence.
  • To assess if aortic knuckle calcification on chest X-ray can serve as a predictive marker.
  • To determine if these markers can obviate the need for preoperative coronary angiography.

Summary:

  • A study of 192 patients undergoing mitral valve replacement found aortic atheroma in 37.5% and coronary stenosis in 18.7%.
  • Univariate analysis showed limited predictive value for aortic atheroma and chest X-ray calcification for CAD.
  • Multivariate analysis identified hypercholesterolemia, smoking, and age as predictors of CAD, not aortic atheroma (p=0.3).

Impact:

  • Aortic atheroma detected by TEE is not a reliable predictor of coronary artery disease in this specific patient group.
  • Chest X-ray calcification offers comparable, but insufficient, diagnostic value.
  • Neither TEE-detected aortic atheroma nor chest X-ray calcification provides adequate negative predictive value to forgo coronary angiography in asymptomatic patients with mitral valve disease.

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