title: Thoracic aortic atheroma severity predicts high-risk coronary anatomy in patients undergoing transesophageal echocardiography.
abstract: BACKGROUND
  We hypothesized a relationship between severity of thoracic aortic atheroma (AA) and prevalence of high-risk coronary anatomy (HRCA).
  
  
  METHODS
  We investigated AA diagnosed by transesophageal echocardiography and HRCA diagnosed by coronary angiography in 187 patients. HRCA was defined as ≥ 50% stenosis of the left main coronary artery or significant 3-vessel coronary artery disease (≥ 70% narrowing).
  
  
  RESULTS
  HRCA was present in 45 of 187 patients (24%). AA severity was grade I in 55 patients (29%), grade II in 71 patients (38%), grade III in 52 patients (28%), grade IV in 5 patients (3%), and grade V in 4 patients (2%). The area under receiver operating characteristic curve for AA grade predicting HRCA was 0.83 (p = 0.0001). The cut-off points of AA to predict HRCA was > II grade. The sensitivity and specificity of AA > grade II to predict HRCA were 76% and 81%, respectively. After adjustment for 10 variables with significant differences by univariate regression, AA > grade II was related to HRCA by multivariate regression (odds ratio = 7.5, p< 0.0001). During 41-month follow-up, 15 of 61 patients (25%) with AA >grade II and 10 of 126 patients (8%) with AA grade ≤ 2 died (p= 0.004). Survival by Kaplan-Meier plot in patients with AA > grade II was significantly decreased compared to patients with AA ≤ grade II (p= 0.002).
  
  
  CONCLUSIONS
  AA > grade II is associated with a 7.5 times increase in HRCA and with a significant reduction in all-cause mortality.
authors.affiliation: Cardiac Center of Creighton, University School of Medicine, Omaha, Nebraska, USA.
authors.forename: Xuedong
authors.initials: X
authors.lastname: Shen
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
authors.forename: Chandra K
authors.initials: CK
authors.lastname: Nair
authors.forename: Hema
authors.initials: H
authors.lastname: Korlakunta
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Holmberg
authors.forename: Fenwei
authors.initials: F
authors.lastname: Wang
authors.forename: Stephanie
authors.initials: S
authors.lastname: Maciejewski
authors.forename: Dennis J
authors.initials: DJ
authors.lastname: Esterbrooks