Related Experiment Videos
Angina pectoris and coronary artery disease in isolated, severe aortic regurgitation
Insights
In patients with severe aortic regurgitation (AR), coronary artery disease (CAD) is common. Angina pectoris (AP) can help predict CAD, but routine coronary angiography is recommended for AR patients over 40.
Area of Science:
- Cardiology
- Cardiovascular Surgery
Background:
- Severe aortic regurgitation (AR) can coexist with coronary artery disease (CAD).
- The relationship between AR, angina pectoris (AP), and CAD requires further investigation to guide treatment decisions.
Purpose of the Study:
- To determine the prevalence of significant CAD in patients with isolated severe AR.
- To evaluate the association between AP and the presence of significant CAD in this patient cohort.
Main Methods:
- Retrospective study of 78 patients with isolated, severe AR.
- Coronary angiography was performed to assess for significant CAD.
- AP symptoms were recorded and analyzed in relation to CAD findings.
Main Results:
- Significant CAD was found in 37% of patients.
- Patients with AP were more likely to have significant CAD (58%) compared to those without AP (19%).
- AP demonstrated a sensitivity of 73% and specificity of 69% for predicting significant CAD.
Conclusions:
- A substantial proportion of patients with severe AR have significant CAD.
- While AP is a useful predictor, it is not definitive; routine coronary angiography is recommended for AR patients over 40 undergoing aortic valve replacement.
- The benefit of concurrent coronary artery bypass grafting during aortic valve replacement for AR is not well-established, reinforcing the need for pre-operative angiography.
Abstract:
Seventy-eight patients with isolated, severe aortic regurgitation (AR) were studied retrospectively to determine the prevalence of angiographically significant coronary artery disease (CAD) and its relation to angina pectoris (AP). Angiographically, significant CAD was present in 29 of 78 patients (37%), and 36 patients (46%) had AP. Twenty-one of 36 patients (58%) with AP and 8 of 42 patients (19%) without AP had angiographically significant CAD. AP as a predictor of significant CAD had a sensitivity of 73%, specificity of 69% and a risk ratio of 3:1. The predictive accuracy of detecting CAD in the absence of AP was 81%. The benefit from concomitant coronary artery bypass grafting at the time of aortic valve replacement for AR has not been clearly demonstrated; therefore, routine coronary angiography is still recommended for all AR patients older than 40 years undergoing aortic valve replacement.