Abstract 12703: Rapid and Accurate Assessment of Aortic Arch Atherosclerosis Using Real-time 3 Dimensional Transesophageal Echocardiography

Abstract

Background: The presence of atherosclerotic plaques in the aortic arch detected by transesophageal echocardiography (TEE) is associated with risk of ischemic stroke. However, to evaluate the aortic arch by TEE, the probe should be positioned high in the oropharynx, and this positioning may cause the patient excessive discomfort and gagging. Recently, real-time 3-dimensional transesophageal echocardiography (3DTEE) has been introduced as a novel technique, which allows simultaneous visualization of orthogonal 2 imaging planes by x-plane method. The purpose of this study was to investigate the feasibility of 3DTEE for the assessment of aortic arch plaques by comparison with conventional 2DTEE.

Methods: The study population consisted of consecutive 152 patients who were clinically referred for TEE (mean age, 66±11 years). Using x-plane method by RT3DTEE, 2 orthogonal imaging planes of aortic arch can be visualized simultaneously, and by moving the reference line on the long axis image of the aortic arch, short axis image across the reference line can be displayed. In all patients, we assessed aortic arch plaques both by 2DTEE and by 3DTEE, and evaluated size and characteristics of arch plaques. Large plaques (≥4mm in thickness), plaques with ulceration, or mobile components were defined as complex plaques. Additionally, in randomly selected 112 of 152 patients, we measured the time needed for data acquisition of aortic arch both by 2DTEE and by 3DTEE.

Results: Aortic arch plaques were detected in 78 of 152 patients (51%), and complex plaques were detected in 22 patients (15%). In all patients with arch plaques detected by 2DTEE, both aortic arch plaques and complex plaques could be detected by 3DTEE. There was a good correlation between 2DTEE and 3DTEE in the measurement of the maximum thickness of aortic arch plaques (r=0.95, mean difference; -0.1±0.5mm). There was a good agreement between 2DTEE and 3DTEE for the detection of arch plaques including complex plaques. The mean acquisition time of aortic arch by 3DTEE was significantly shorter than that by 2DTEE (P<0.0001).

Conclusions: 3DTEE can provide rapid and accurate evaluation of aortic arch plaques. Therefore, 3DTEE is useful tool for the assessment of aortic arch plaques in the clinical setting.