The aim of this study was to determine the relationship between plaques of aor tic atheroma detected by transoesophageal echocardiography and the condition of the coronary arteries at coronary angiography. Two hundred and seventeen consecu tive patients were included for systematic transoesophageal echocardiography bli nded to the results of coronary angiography. Significant coronary disease was de fined as stenosis of at least 70%of the artery lumen. Aortic atherosclerosis wa s classified in four grades. The average age of the patients was 54.5±10.5 year s. The sex ratio was 2.55 in favour of men. The average coronary score was 5±4. 5 and the lesion index was 1.1±0.96. One hundred and fifty nine patients had a ortic atheroma,73%of which (80 cases) were complex lesions. The descending aort a was the commonest site (91%) followed by the transverse (40%and ascending ao rta (14%). When the ascending aorta was affected there was a very significant a ssociation with coronary artery disease (100%of cases). Sixty one per cent of patients had lesions of one aortic segment, 28%had lesions of two aortic segmen ts and in 10%, all three aortic segments were involved. The presence of aortic atheroma was correlated with coronary artery disease with a sensitivity and spec ificity of 86%and 76%respectively. The positive and negative predictive values were 81%and 31%respectively. Seventy five per cent of patients with a corona ry score of at least 7 had aortic atheroma with complex lesions in 47%of cases. The lesion index was significantly higher in this group when the coronary score was less than 7 (1.98±0.8 vs 0.65±0.7, p< 0.00001). Patients with coronary ar tery disease have more complex lesions of the descending than of the ascending a orta (94 vs 25%). Significant coronary artery disease was correlated with the p resence of aortic atheroma, especially of the ascending aorta. The specificity a nd positive predictive values were 100%but the negative predictive value was po or, irrespective of the aortic segment involved (32%for the ascending aorta, 36 %for the transverse and 35%for the descending aorta). The authors conclude tha t transoesophageal echocardiography of the thoracic aorta is a good method of pr edicting severe coronary atherosclerotic disease.
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