DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20214415

Incidence of coronary artery disease before valvular replacement in isolated severe aortic stenosis patients in Western Rajasthan

Ramesh Patel, Sandeep Aggarwal

Abstract


Background: The aim of the study was to evaluate the incidence of Coronary artery disease (CAD) and predictors of CAD in patients with severe AS in western Rajasthan population.

Methods: Data from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Udaipur were entered in a prospective registry beginning in 2015. Significant CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70% and left main coronary arteries having an estimated narrowing of ≥50% on coronary angiography. We excluded patients with multiple valve disease, significant aortic regurgitation, or prior CAD or valve surgery.

Results: Mean age of 55 enrolled patients was 52.64±15.5 years. Diabetes mellitus and hypertension were present in 3.64% and 5.45% of patients, respectively. Moderate and severe Left ventricular ejection fraction (LVEF) was found in 16.36% and 10.91% patients, respectively. Only 5.45% patient had severe CAD and thus underwent AVR and coronary artery bypass grafting, and rest 94.55% patients underwent AVR. Mean age of patients who underwent AVR was 51.75±15.36 years and who underwent AVR and CABG was 68±11.14 years with no significant association (p=0.078). Proportion of patients requiring AVR and CABG was significantly higher in moderate (22.22%) and severe LVEF (16.67%) as compared to normal or mild (p=0.034).

Conclusions: Coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients above 68 years of age without risk factors for cardiovascular disease. However, larger studies on heterogeneous population are required to prove our findings.

 


Keywords


Severe aortic stenosis, Coronary artery disease, Coronary angiography, Aortic valve replacement

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References


Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440-63.

Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, Flachskampf F, et al. Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J. 2007;28(2):230-68.

Exadactylos N, Sugrue DD, Oakley CM. Prevalence of coronary artery disease in patients with isolated aortic valve stenosis. Br Heart J. 1984;51(2):121-4.

Green SJ, Pizzarello RA, Padmanabhan VT, Ong LY, Hall MH, Tortolani AJ. Relation of angina pectoris to coronary artery disease in aortic valve stenosis. Am J Cardiol. 1985;55(8):1063-5.

Faggiano P, Frattini S, Zilioli V, Rossi A, Nistri S, Dini FL, Lorusso R, et al. Prevalence of comorbidities and associated cardiac diseases in patients with valve aortic stenosis. Potential implications for the decision-making process. Int J Cardiol. 2012;159(2):94-9.

Harris CN, Kaplan MA, Parker DP, Dunne EF, Cowell HS, Ellestad MH. Aortic stenosis, angina, and coronary artery disease. Interrelations. Heart. 1975;37:656-61.

Mullany CJ, Elveback LR, Frye RL, Pluth JR, Edwards WD, Orszulak TA, et al. Coronary artery disease and its management: influence on survival in patients undergoing aortic valve replacement. J Am Coll Cardiol. 1987;10(1):66-72.

Hakki AH, Kimbiris D, Iskandrian AS, Segal BL, Mintz GS, Bemis CE. Angina pectoris and coronary artery disease in patients with severe aortic valvular disease. Am Heart J. 1980;100(4):441-9.

Monsuez JJ, Drobinski G, Verdière C, Chollet D, Grosgogeat Y. Prospective study of the prevalence of coronary involvement in isolated aortic stenosis. Ann Cardiol Angeiol (Paris). 1985;34(2):65-9.

Saito S, Yamagishi M, Takayama T, Chiku M, Koyama J, Ito K, et al. Plaque morphology at coronary sites with focal spasm in variant angina: study using intravascular ultrasound. Circ J. 2003;67(12):1041-5.

Park NH, Hur SH. Prevalence of coronary artery disease in patients who underwent valve surgery in Korea. Korean J Med. 2012;83:62-4.

Bonchek LI, Anderson RP, Rösch J. Should coronary arteriography be performed routinely before valve replacement? Am J Cardiol. 1973;31(4):462-6.

Branch KR, O'Brien KD, Otto CM. Aortic valve sclerosis as a marker of active atherosclerosis. Curr Cardiol Rep. 2002;4(2):111-7.

Otto CM, Kuusisto J, Reichenbach DD, Gown AM, O'Brien KD. Characterization of the early lesion of 'degenerative' valvular aortic stenosis. Histological and immunohistochemical studies. Circulation. 1994;90(2):844-53.

Roberts WC, Ko JM. Frequency by decades of unicuspid, bicuspid, and tricuspid aortic valves in adults having isolated aortic valve replacement for aortic stenosis, with or without associated aortic regurgitation. Circulation. 2005;111(7):920-5.

Ramsdale DR, Bennett DH, Bray CL, Ward C, Beton DC, Faragher EB. Angina, coronary risk factors and coronary artery disease in patients with valvular disease. A prospective study. Eur Heart J. 1984;5(9):716-26.

Vandeplas A, Willems JL, Piessens J, Geest H. Frequency of angina pectoris and coronary artery disease in severe isolated valvular aortic stenosis. Am J Cardiol. 1988;62(1):117-20.