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Assessment of a predictive index for coronary artery disease in patients with rheumatic valvular disease
Victor Manuel Salas-Lara1, Alberto Rangel-Abundis, Sergio Solorio-Meza
1Servicio de Hemodinámica, Centro Médico Nacional La Raza, Instituto Mexicano del Seguro Social, Mexico.
Insights
This study found a prognostic index useful for ruling out significant coronary artery disease in rheumatic heart valve disease patients. However, it cannot reliably identify those with significant coronary artery disease.
Area of Science:
- Cardiology
- Preventive Medicine
- Diagnostic Accuracy
Background:
- Rheumatic heart valvulopathy can coexist with coronary artery disease.
- Accurate prediction of coronary artery disease in these patients is clinically important.
Purpose of the Study:
- To evaluate the diagnostic performance of a prognostic index for significant coronary artery disease in patients with rheumatic cardiac valvulopathy.
Main Methods:
- Prospective, observational, cross-sectional study of 102 patients (age 30-78) with rheumatic valve cardiopathy undergoing coronary angiography.
- Index components included blood pressure, smoking history, angina severity, family history, age, and lipid ratios.
Main Results:
- Significant coronary artery atherosclerosis was found in 7.84% of patients.
- The index demonstrated 50% sensitivity and 80.85% specificity.
- Positive predictive value was 0.18 and negative predictive value was 0.95.
Conclusions:
- The prognostic index is valuable for excluding significant coronary artery disease in rheumatic heart valvulopathy.
- The index is not effective for identifying significant coronary artery disease in this patient population.
Objective:
The authors studied the sensitivity and specificity, as well the positive and negative predictive values, of a prognostic index conformed by diastolic blood pressure, total number of cigarettes smoked during the lifetime, severity of angina pectoris, positive family history of ischemic heart diseases, age (years), current cigarette smoking, and total to HDL-cholesterol ratio in order to anticipate the presence of significant coronary artery disease in patients with rheumatic cardiac valvulopathy.
Material And Methods:
A prospective, observational, non-randomized, cross-sectional and comparative study was performed in men and women > or = 30 and < or = 78 years of age, with rheumatic valve cardiopathy and who were submitted to catheterization and coronary angiography.
Results:
We studied 102 patients (61 women and 41 men) 55.63 +/- 9.88 years of age, range: 30-78 years (women 56.09 +/- 11.48, and men 54.6 +/- 11.35 years of age, respectively). The patients had mitral valve disease 30 (29.41%), 49 (48.03%) had mitral valve disease associated with aortic valve disease and 23 (22.55%) had aortic valvular disease. Significant coronary artery atherosclerosis was present in eight patients (7.84%). Sensitivity and specificity analysis resulted as follows: sensitivity, 50% and specificity, 80.85%. Positive predictive value was 0.18 and negative predictive value 0.95.
Conclusions:
The index analyzed here is useful to predict cases without significant coronary artery disease in patients with rheumatic heart valvulopathy, but this index is not useful to identify significant coronary artery disease in such patients.
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