Related Experiment Videos
Risk factors for coronary artery stenosis in valvular heart disease
E Orlowska-Baranowska1, I Rawczynska-Englert
1National Institute of Cardiology, Warsaw, Poland.
Insights
Significant coronary artery stenosis (SCS) is common in valvular heart disease (VHD) patients, especially with risk factors. Coronary angiography may be unnecessary for younger VHD patients without risk factors or angina before surgery.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Diagnostic Imaging
Background:
- Valvular heart disease (VHD) can coexist with coronary artery disease (CAD).
- The frequency of significant coronary artery stenosis (SCS) in VHD patients and its relation to angina and risk factors require clarification.
- The necessity of pre-operative coronary angiography in all VHD patients is debated.
Purpose of the Study:
- To determine the incidence of SCS in patients with VHD.
- To investigate the correlation between SCS, angina pectoris, and cardiovascular risk factors.
- To evaluate the need for routine coronary angiography before VHD surgery.
Main Methods:
- Retrospective analysis of 1292 VHD patients who underwent coronary angiography before surgery (1982-1990).
- Data collected included presence of angina pectoris and risk factors: smoking, hypertension, family history of ischemic heart disease, elevated lipids, diabetes, and overweight.
- Correlations between SCS, angina, and risk factors were assessed.
Main Results:
- The overall incidence of SCS was 13%, higher in patients with angina.
- SCS correlated significantly with smoking, hypertension, family history of ischemic heart disease, elevated lipids, and diabetes, but not overweight.
- SCS incidence increased with the number of risk factors (2% with none, 6% with one, 21% with ≥2).
- No SCS was found in patients <55 years without risk factors and angina.
Conclusions:
- A strong correlation exists between the number of cardiovascular risk factors and the presence of significant coronary artery disease in VHD patients.
- Coronary angiography may not be mandatory before valve replacement in patients under 55 years old who present with no angina and no risk factors.
Background And Aims Of The Study:
The study was performed to establish the frequency of significant coronary artery stenosis (SCS) in patients with valvular heart disease (VHD), and in particular its correlation with the incidence of angina pectoris and presence of coronary risk factors. The need for coronary arteriography to be performed in all patients with VHD before surgery was also investigated.
Methods:
Retrospective examinations were performed in 1292 patients with VHD (mean age 51 years) who underwent selective coronary angiography before surgery between 1982 and 1990. In each patient the presence of angina pectoris and the following risk factors were noted: cigarette smoking, systemic hypertension, family history of ischemic heart disease, elevated fasting serum lipids, history of diabetes mellitus and overweight.
Results:
The incidence of SCS was 13%, was higher in patients with angina, and correlated significantly with coronary risk factors of smoking, hypertension, history of ischemic heart disease, elevated lipids and diabetes, but not with overweight. The incidence of SCS increased progressively with the number of coronary risk factors, from 2% in patients without risk factors, to 6% with one risk factor, and to 21% with two or more risk factors. SCS was not found in patients without coronary risk factors and without angina pectoris below 55 years of age.
Conclusions:
A statistically significant correlation was found between increasing numbers of coronary risk factors and significant coronary artery disease. These results suggest that coronary angiography may not be an obligatory diagnostic step before valve replacement in patients aged < 55 years who have neither risk factors nor angina pectoris.