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Frequency of angiographically significant coronary arterial narrowing in mitral stenosis
Insights
Severe mitral stenosis in patients over 40 often coexists with coronary artery disease (CAD). This significant CAD is frequently silent, meaning it presents without typical angina pectoris symptoms.
Area of Science:
- Cardiology
- Cardiovascular Research
- Clinical Medicine
Background:
- Severe mitral stenosis (MS) is a significant valvular heart disease.
- Coronary artery disease (CAD) is a common comorbidity in older adults.
- The relationship between MS and CAD, particularly the presentation of CAD in MS patients, requires further investigation.
Purpose of the Study:
- To investigate the prevalence and clinical presentation of coronary artery disease (CAD) in patients over 40 years old with severe mitral stenosis (MS).
- To determine the association between angina pectoris (AP) and the presence of significant CAD in this patient cohort.
Main Methods:
- Retrospective analysis of 96 consecutive patients older than 40 years with severe mitral stenosis.
- Assessment of angiographically significant coronary artery disease (CAD) and the presence or absence of angina pectoris (AP).
- Statistical analysis to evaluate the diagnostic accuracy of AP for detecting significant CAD and to compare hemodynamic parameters.
Main Results:
- Twenty-seven percent (27/96) of patients had significant CAD.
- Of patients with AP, 48% had significant CAD; of patients without AP, 23% had significant CAD.
- Angina pectoris demonstrated a specificity of 84% and a sensitivity of 37% for detecting significant CAD. Pulmonary artery pressures and resistance did not differ between groups.
Conclusions:
- Coexistent coronary artery disease (CAD) is common in patients over 40 with severe mitral stenosis (MS).
- Significant CAD in this population is frequently clinically silent, presenting without angina pectoris.
- Current diagnostic criteria relying on angina may underestimate CAD prevalence in severe MS patients.
Abstract:
Ninety-six consecutive patients older than 40 years with severe mitral stenosis were retrospectively analyzed to determine the relation of angina pectoris (AP) and coexistent coronary artery disease (CAD). Of the 96 patients, 27 (28%) had angiographically significant CAD, 10 (37%) with AP and 17 (63%) without AP. Of the 96 patients, 21 had AP, 10 (48%) with angiographically significant CAD and 11 (52%) without (CAD). Of 75 patients without AP, 17 (23%) had angiographically significant CAD AP had a specificity of 84% and a sensitivity of 37% in its ability to detect significant CAD. The pulmonary artery systolic, diastolic and mean pressures and the pulmonary vascular resistance did not differ between patients with and those without AP (p greater than 0.05). It is concluded that coexistent CAD is commonly found in patients older than age 40 with severe MS, and is usually clinically silent.