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Relation of systemic arterial pulse pressure to coronary atherosclerosis in patients with mitral stenosis
1College of Medicine, National Taiwan University, Taipei, Republic of China.
Insights
A wide pulse pressure in patients with mitral stenosis (MS) is linked to a higher likelihood of coronary artery disease (CAD). This finding highlights pulse pressure as a key indicator for cardiovascular risk in MS patients.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Tools
Background:
- The association between elevated systemic arterial pulse pressure and coronary atherosclerosis requires further clarification.
- Mitral stenosis (MS) is a condition that can affect cardiovascular health.
- Coronary artery disease (CAD) is a significant concern in patients with cardiovascular conditions.
Purpose of the Study:
- To investigate the relationship between wide systemic arterial pulse pressure and the presence of coronary atherosclerosis in patients with symptomatic mitral stenosis.
- To identify predictors of coronary artery disease in this patient population.
Main Methods:
- Retrospective analysis of 159 patients over 40 with symptomatic mitral stenosis undergoing coronary angiography.
- Classification into groups based on the presence (>= 50% diameter narrowing) or absence of significant coronary artery disease.
- Pulse pressure measurement using both noninvasive sphygmomanometry and invasive catheterization.
- Multivariate logistic regression analysis to identify independent predictors of CAD.
Main Results:
- A wide pulse pressure (>= 60 mm Hg) was significantly associated with the presence of angiographically significant coronary artery disease.
- Independent predictors for CAD in MS patients included age, gender, mean blood pressure, and pulse pressure.
- Sphygmomanometry-derived pulse pressure provided clinically relevant information regarding CAD risk.
Conclusions:
- Wide pulse pressure is a significant indicator associated with a high incidence of coronary artery disease in patients with mitral stenosis.
- Pulse pressure measurement, even noninvasively, can offer valuable insights into cardiovascular risk in MS patients.
- Further research may explore therapeutic strategies targeting pulse pressure in MS patients to mitigate CAD risk.
Abstract:
The relation of a wide systemic arterial pulse pressure to coronary atherosclerosis has not been fully defined. One hundred fifty-nine patients > 40 years old with symptomatic mitral stenosis (MS) who received routine coronary angiography were classified into 2 groups according to the presence of > or = 50% diameter narrowing of > or = 1 coronary artery (n = 48) or no significant disease (n = 111). Pulse pressure was determined both by noninvasive sphygmomanometer and invasive catheterization methods. There were no significant differences in risk factors of coronary artery disease (CAD) or the severity of MS between the 2 groups. From multivariate logistic regression analysis, independent predictors of development of CAD in MS were age (standardized coefficient beta = 1.3437, p = 0.0025), gender (beta = 0.0107, p = 0.0105), mean blood pressure (beta = 1.1839, p = 0.0105), and pulse pressure (beta = 1.3157, p = 0.0008). A wide pulse pressure (> or = 60 mm Hg) correlated with the presence of angiographically significant CAD with a sensitivity and specificity of 88% and 77%. The negative predictive value was 93%. Pulse pressure assessed by sphygmomanometry provided important clinical information. A wide pulse pressure in patients with MS was associated with a high incidence of CAD.