Aortic stenosis, angina pectoris, coronary artery disease

Abstract

The data from 88 patients (pts) with aortic stenosis (AS) were reviewed to determine relationships between angina pectoris (AP) and coronary artery disease (CAD). Results of surgery performed in 81 of these pts was analyzed. All pts had coronary arteriograms, and lesions greater than or equal to 50% were considered significant. Fifty-nine pts had an aortic valve gradient measured at catheterization greater than or equal to 40 mmHg, and in 29 pts, AS was confirmed at operation. Sixty-eight pts (77%) experienced AP, and 32 had coexisting CAD (47%); 9 of 20 pts without AP had CAD (45%). There were no significant differences in the incidence of AP in pts divided into subgroups by the aortic valve gradient (40-50, 51-100, 101-200 mmHg) or age (40-59, 60-81 years). Also, no significant differences were found in the incidence or extent of CAD between the two age groups; the extent of CAD was similar regardless of the presence or absence of AP. In pts with AP (1) CAD was more likely in pts greater than or equal to 60 years of age; (2) CAD was less likely when the aortic valve gradient was greater than 100 mmHg, suggesting that AP in these pts was due to hemodynamically severe AS. All pts with 3-vessel CAD experienced AP, and the aortic valve gradient was less in these pts than in those with no CAD or less extensive CAD. In 19 pts with combined AS and CAD who had both the aortic valve replaced and a revascularization operation only 1 of pts died in the hospital, while 3 of 19 pts with combined AS and CAD who had aortic valve replacement alone died. In this study a significant number of pts with AS experienced AP, and the presence or absence of AP did not predict coexisting CAD. Coronary arteriography is recommended in the evaluation of pts greater than or equal to 40 years of age with AS. The operative mortality appears to be decreased in pts with AS and CAD who have combined surgery.

Prevalence of Coronary Artery Disease in Patients With Valvular Heart Disease

“…In comparison to mitral valve disease, aortic valve disease and combined lesion have significantly higher chance of coronary artery disease (p=0.001). The findings are supported by Moraski RE et al [12] and Lacy J et al [13] CONCLUSION Overall prevalence of significant coronary artery disease in patients with valvular heart disease is 14.28% in this part of the country. Prevalence of coronary artery disease in rheumatic valvular heart disease is 9.26%, while in nonrheumatic valvular heart disease it is 44.44%.…”

Evaluation of the prevalence of coronary artery disease in patients with valvular heart disease

“…In the study by Chun et al, 82 patients with MS underwent CAG, and 21 patients (26%) were found to have CAD [7]. Similar studies on patients with aortic stenosis reported a 56% prevalence rate for CAD [8],[9]. In the study by Shaikh et al that evaluated 144 patients who underwent replacement of mitral valve, aortic valve or both, there was evidence for severe CAD in 32.9% of the patients who underwent MVR, 31.9% of the patients who underwent AVR, and 25% of the patients who underwent the replacement of both valves [10].…”

Incidence of coronary artery disease in patients with valvular heart disease.

“…In addition, there are some patients without angina who still have significant coronary obstruction.3 [8][9][10] In patients being considered for valve surgery it is generally accepted that the presence of angina is an indication for coronary arteriography as part of the preoperative investigations.' 8 …”