Pathophysiology, Diagnosis, and Treatment of Patients with Concomitant Severe Aortic Stenosis and Coronary Artery Disease: A Closer Look to the Unresolved Perplexity

Abstract

Degenerative aortic stenosis (AS) and coronary artery disease (CAD) are the most prevalent cardiovascular diseases in developed countries, and they coexist in up to 50% of patients. The pathophysiological rationale behind concomitant AS and CAD is discussed in detail in this review, together with prognostic implications. Detecting CAD in patients with AS may be challenging, as AS may mask the existence and symptoms of CAD. The safety and reliability of invasive and non-invasive physiological assessment for epicardial coronary disease are also a matter of debate. Finally, the selection and timing of optimal treatment of CAD in patients with severe AS are still unclear. Given the aging of the population, the increase in the prevalence of AS, and the ongoing paradigm shift in its treatment, controversies in the diagnosis and treatment of CAD in the setting of AS are deemed to grow in importance. In this paper, we present contemporary issues in the diagnosis and management of CAD in patients with severe AS who are transcatheter aortic valve implantation (TAVI) candidates and provide perspective on the treatment approach.

Exploring the mediating role of calcium homeostasis in the association between diabetes mellitus, glycemic traits, and vascular and valvular calcifications: a comprehensive Mendelian randomization analysis

“…The observed associations between DM and cardiovascular calcifications align with the growing body of literature suggesting that metabolic syndromes contribute to cardiovascular risks [ 9 , 11 , 32 ]. On the other hand, our study aligns with existing literature that identifies HbA1c levels as predictors of cardiovascular calcifications.…”

Challenges in Diagnosis and Functional Assessment of Coronary Artery Disease in Patients With Severe Aortic Stenosis

“…Degenerative aortic stenosis (AS) is the most common valvular heart disease in both western and developed countries, affecting mainly individuals older than 60 years (1)(2)(3)(4). Co-existing coronary artery disease (CAD) is present in more than 50% of patients with severe AS over 70 years of age and in more than 65% of patients with severe AS over 80 years of age (2,3,5).…”

The predictive role of fully revascularized coronary artery disease in patients undergoing transaortic valve implantation

“…Затова и резултатите са противоречиви. Обект на дискусии е и най-правилният момент за перкутанна коронарна интервенция при тези пациенти (на два етапа -перкутанна коронарна интервенция преди или след транскатетърна имплантация на аортна клапа, или едноетапно) [31]. Това налага провеждането на рандомизираното клинично проучване -ACTIVATION [32], сравняващо две групи пациенти с ИБС -подложени на перкутанна коронарна интервенция преди TAVI и пациенти, при които не е проведена реваскуларизация преди TAVI.…”