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Angina pectoris and coronary artery disease in severe aortic regurgitation
P Timmermans1, J L Willems, J Piessens
1Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
Insights
Coronary artery disease (CAD) affects 14% of patients with severe aortic regurgitation. Angina symptoms and risk factors can help identify patients who may not need coronary arteriography.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Severe aortic regurgitation can coexist with coronary artery disease (CAD).
- Identifying CAD in these patients is crucial for treatment planning.
- Coronary arteriography is the gold standard but invasive.
Purpose of the Study:
- To determine the prevalence of significant CAD in patients with isolated severe aortic regurgitation.
- To assess the relationship between CAD, angina pectoris, and coronary risk factors.
- To evaluate the utility of clinical factors in predicting CAD, potentially avoiding coronary arteriography.
Main Methods:
- Retrospective study of 198 patients with pure, isolated, severe aortic regurgitation.
- Analysis of angiographically significant coronary artery disease (stenoses >50%).
- Evaluation of angina symptoms (typical and atypical) and traditional coronary risk factors.
Main Results:
- Significant CAD was found in 14% of patients.
- Typical angina was present in 18%, atypical chest pain in 16%.
- A multivariate risk score improved sensitivity for CAD detection to 74% with equal specificity.
Conclusions:
- Coronary arteriography may be safely omitted in severe aortic regurgitation patients without ischemic symptoms or risk factors.
- Clinical assessment, including a risk score, can guide decisions regarding coronary arteriography.
- This approach can reduce unnecessary invasive procedures in select patient groups.
Abstract:
A consecutive series of 198 patients (148 men and 50 women, mean age 51 years, range 18 to 76) with pure, isolated, severe aortic regurgitation was retrospectively studied to determine the prevalence of angiographically significant coronary artery disease (CAD) and its relation to angina pectoris and coronary risk factors. Significant CAD (coronary diameter stenoses greater than 50%) was found in 28 patients (14%). Typical angina was present in 18% and atypical chest pain in 16%. Angina alone had a sensitivity of 57% to detect significant CAD. The predictive accuracy of a positive history of angina was 46% and that of a negative test 93%. By using multivariate logistic regression, a risk score could be calculated that increased the sensitivity to 74% at equal specificity. Almost 40% of the total population had a risk score of less than -2.9 (only 1 patient in this group had CAD). It is concluded that coronary arteriography can safely be omitted in many patients with severe aortic regurgitation if they have no symptoms of myocardial ischemia or risk factors known to increase its incidence.