Multiple aortic root echoes: clinical, radiographic, and angiographic correlations.

Multiple diastolic echoes in the aortic root on M-mode echocardiography may represent fibrosis or calcification of the aortic wall, aortic leaflets, or proximal portions of the coronary arteries. In this study, 83 patients with multiple diastolic echoes were evaluated by cardiac fluoroscopy and the incidence of valvular, coronary, and aortic wall calcification was determined. In patients with multiple diastolic echoes who have no evidence of significant aortic stenosis (aortic valve opening less than or equal to 1.0 cm) or aortic insufficiency (fine fluttering of the anterior leaflet of the mitral valve), the presence of multiple diastolic echoes was highly associated with significant coronary artery calcification (64%) with over two-thirds having multivessel involvement. Patients referred for echocardiography who are free of significant aortic stenosis or aortic insufficiency by echocardiographic criteria who are found to have multiple diastolic echoes in the aortic root should be evaluated further for the possible presence of significant multivessel coronary artery disease.