Estenose aórtica e doença coronariana: análise dos fatores de risco

Abstract

Original Article M a i l i n g A d d r e s s : C l a u d i o M a g a l h ã e s R a n g e l • R u a I t a p e v a , 2 4 0 -0 1 3 3 2 -0 0 0 -S ã o P a u l o , S P -B r a z i l E-mail: cmsrangel@terra.com. OBJECTIVETo analyze clinical laboratorial aspects of the presence of coronary disease in patients with aortic stenosis and evaluate the infl uence of risk factors in the development of obstructive coronary disease. METHODSWe studied 65 patients who had severe aortic stenosis with an indication for surgery, ages 51 to 85 years, 40 of them women. The coronary angiography assessment resulted in two groups: 26 (40%) with obstructive coronary disease and 39 (60%) with no coronary artery lesion. Personal antecedents for coronary disease (smoking, dyslipidemia, diabetes mellitus, arterial hypertension, family antecedents, sedentarism, and alcoholism) were analyzed. Additionally, the following assessments were made: electrocardiogram, echocardiogram with Doppler, and laboratory tests (blood glucose, total cholesterol and fractions, triglycerides, Apo-A1 and B, fi brinogen, lipoprotein (a) and fraction of triglycerides and cholesterol removal in both groups.

Prevalência de doença arterial coronariana e avaliação pré-operatória em portadores de valvopatia

“…The absolute sample of patients with mitral valvopathy was high, including its association with CAD. However, when a proportional assessment was made, we observed a higher frequency of association between aortic stenosis and CAD, in the region of 10%, which is similar to the findings of other studies 11,12 . The older age group and the predominance of male subjects may explain these findings.…”

“…Noninvasive evaluation techniques such as electrocardiography, chest X-ray, Doppler echocardiography, scintigraphy and, more recently, angiotomography, when combined with clinical examination, can clarify, in most cases, the etiology, the degree of valve lesion, and whether there is ventricular dysfunction. The hemodynamic study played a diagnostic role in only 10% of the patients with valvopathy [11][12][13][14][15] . Additionally, there are issues relating to the high cost and risks which are inherent to invasive tests, such as vascular lesion resulting from the insertion of the catheter, anaphylactic shock and/or kidney dysfunction due to the iodinated contrast media and even an epysode of cerebrovascular accident due to calcium embolism or thrombus 13 .…”

Estenose aórtica severa em idosos: avaliação clínica, eletrocardiográfica, ecocardiográfica e angiográfica

“…Esse resultado sugere que a presença desse sinal, ao ECG convencional, não é constante no diagnóstico de EAo em idosos. É possí-vel que a falta de diagnóstico de sobrecarga ventricular esquerda, por meio da eletrocardiografia, esteja relacionada à baixa sensibilidade do índice de Sokolow, quando comparado com outros métodos eletrocardiográfi-cos, 15,21 como por exemplo o índice de Cornell. Dos 23 pacientes que apresentavam índi-ce de Cornell positivo, um não apresentava HVE ao ecocardiograma (4,3% de falsos positivos).…”

“…Verifica-se certa correlação entre idade e taxa de coronariopatia, em que a faixa etária maior tem maior probabilidade de doença coronariana associada a estenose aórtica. [13][14][15][16][17] A presença de doença coronariana em pacientes com estenose aórtica tem sido motivo de muitos estudos, e alguns autores têm sugerido a correlação entre fatores de risco (hipertensão, diabetes, dislipidemias, tabagismo) e presença de coronariopatia no paciente valvar aórtico.…”