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[Aortic stenosis and coronary pathology. Their implications for the transvalvular gradient]
Insights
Coronary artery disease is common in patients with aortic stenosis, impacting ejection fraction and limiting the use of peak systolic valvular gradient. Coronary angiography is recommended regardless of chest pain presence.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Valvular aortic stenosis (AS) is a common valvular heart disease.
- Coronary artery disease (CAD) prevalence in AS patients requires further investigation.
- The relationship between AS severity indices and CAD is not fully understood.
Purpose of the Study:
- To determine the incidence of CAD in patients with valvular AS.
- To assess the impact of CAD on peak systolic valvular gradient (PSVG) and ejection fraction (EF).
- To evaluate the necessity of coronary angiography in AS patients.
Main Methods:
- Cardiac catheterization was performed on 31 consecutive patients with valvular AS.
- Coronary angiography assessed significant CAD (>50% luminal diameter reduction).
- Statistical analysis correlated CAD presence with risk factors, age, angina, PSVG, and EF.
Main Results:
- Significant CAD was found in 54.8% of AS patients.
- CAD prevalence was not correlated with age or typical angina.
- Patients with CAD had significantly lower ejection fraction (45% vs. 65.1%) and a reverse correlation with PSVG (p=0.006).
Conclusions:
- Peak systolic valvular gradient is a limited index for AS severity in patients with concomitant CAD.
- The presence of CAD significantly affects ejection fraction in AS patients.
- Coronary angiography is essential for all AS patients, irrespective of angina symptoms, to align with ACC/AHA guidelines.
Abstract:
To assess the incidence of coronary artery disease in patients with valvular aortic stenosis and its implication on peak systolic valvular gradient, 31 consecutive patients who underwent cardiac catheterization were examined. Associated significant coronary artery disease (> 50% reduction in luminal diameter evaluated in proximal segments and right dominant circulation) was present in 54.8% of patients. There was no difference in the distribution of risk factors among patients with and without significant luminal narrowings. The prevalence of coronary artery disease was found not to be significantly correlated with age (p = 0.276). There was no relationship between typical angina pectoris and the presence of coronary artery disease (p = 0.063). Fourty-seven percent of cases resulted free of chest pain. Ejection fraction was found to be significantly lower in patients with coronary artery disease (45 +/- 14.2%) than in patients without coronary artery disease (65.1 +/- 3.9%; p = 0.03) and a reverse relationship was observed between the presence of coronary artery disease and peak systolic valvular gradient (p = 0.006) which, in turn, correlated significantly with ejection fraction (r = 0.68; p = 0.023). These data demonstrate that the value of peak systolic valvular gradient, as the only index for the evaluation of the severity of aortic stenosis, is greatly limited in patients with associated coronary artery disease. Moreover, confirming the guidelines of the American College of Cardiology and of the American Heart Association task force, these data also stress the necessity of performing coronary angiography regardless angina pectoris is present or not.