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Coronary arteriography in isolated aortic and mitral valve disease
Insights
Angina is an unreliable indicator of coronary artery disease (CAD) in patients with aortic or mitral valve issues. Coronary arteriography is recommended for pre-operative assessment in patients over 40 with these conditions.
Area of Science:
- Cardiology
- Vascular Medicine
- Cardiac Surgery
Background:
- Coronary artery disease (CAD) and valvular heart disease often coexist.
- The diagnostic utility of angina pectoris (AP) in identifying CAD in patients with valvular disease is unclear.
- Pre-operative assessment is crucial for patients undergoing cardiac surgery.
Purpose of the Study:
- To investigate the relationship between obstructive CAD and AP in patients with isolated aortic or mitral valve disease.
- To determine the reliability of AP as a marker for CAD in these patient populations.
- To inform the appropriate use of coronary arteriography in pre-operative evaluations.
Main Methods:
- Retrospective review of coronary arteriographic findings in 200 patients.
- Analysis of patients with isolated aortic valve disease (n=100) and mitral valve disease (n=100).
- Correlation of CAD (stenosis >50%) with the presence or absence of AP.
Main Results:
- AP was an unreliable marker for CAD in aortic valve disease and mitral incompetence.
- In mitral stenosis, CAD was uncommon without AP (p < 0.0001).
- Asymptomatic CAD was more prevalent in mitral incompetence (p < 0.005).
Conclusions:
- Coronary arteriography is indicated for pre-operative assessment in patients >= 40 years with aortic valve disease or mitral incompetence.
- The value of coronary arteriography is limited in mitral stenosis patients without AP.
- AP is not a reliable indicator of CAD in most valvular heart disease patients.
Abstract:
Coronary arteriographic findings in 200 patients with isolated aortic and mitral valve disease were reviewed to examine the relationship between obstructive (greater than 50% diameter stenosis) coronary artery disease (CAD) and angina pectoris (AP). Of 100 patients with aortic valve disease, 30 had CAD of whom 20 gave a history of AP. Thirty-two of 52 patients (61%) with AP did not have CAD and 10 of 48 (21%) had CAD without AP. CAD was evenly distributed among patients with aortic stenosis, incompetence and mixed aortic valve disease. CAD was found in 23 of 100 patients with mitral valve disease. Sixteen of 32 patients with mitral incompetence had CAD of whom four had AP. Seven of 68 patients with mitral stenosis or mixed mitral valve disease had CAD. AP was noted by four of these seven patients but by none of the 61 with normal coronary arteriograms (p less than 0.0001). Asymptomatic CAD was more common among patients with mitral incompetence (12/28 vs 3/64 p less than 0.005). AP was an unreliable marker for CAD in aortic valve disease or mitral incompetence. Conversely, CAD was uncommon without AP in mitral stenosis or mixed mitral valve disease. Coronary arteriography seems indicated in the pre-operative assessment of patients aged greater than or equal to 40 years with aortic valve disease or mitral incompetence. Its value is limited in patients with mitral stenosis or mixed mitral valve disease without AP.