[Angina pectoris in patients with aortic valvular stenosis]. / Bóle wiencowe u chorych ze zwezeniem lewego ujscia tetniczego.

AIM: The aim of the study was to analyze the factors contributing to the development of anginal pain common in patients with aortic valvular stenosis (SOAS). METHODS: The study included 74 consecutive patients, aged 60,5 (+/- 10,7), with severe acquired valvular aortic stenosis (resting maximum systolic pressure gradient above 50 mm Hg) who were referred for evaluation prior to elective cardiac surgery. The history of angina and its severity according to CCS classification and of common atherosclerosis risk factors including: hypertension, hyperlipidaemia, smoking, diabetes mellitus and family history was taken. The laboratory tests included: lipidogram, white blood count and serum creatinine. The transthoracic echocardiography (TEE) date were collected: LVEDd, IVSDd, LVPWDd, LAd, EF, SF, SV, EDV, ESV, maximum systolic transvalvular pressure gradient and degree of aortic insufficiency. Coronary angiography was then performed. The presence of severe atherosclerosis was defined as more than 50% stenosis of one of three main coronary arteries: right, anterior descending or circumflex artery. Haemodynamic protocol involved LVEDP, PCWP, CO, PASP, aortic pressure gradient and aortic insufficiency evaluation. RESULTS: Patients with severe anginal symptoms (CCS III/IV) were older, had higher LDL cholesterol and triglycerides concentrations, more often had obesity and positive family history of ischemic heart disease than patients with mild (CCS I/II) or without symptoms. They had also higher number of vessels with significant stenosis which most frequently presented in left anterior descending artery. The maximum systolic pressure gradient according to TTE as well as to invasive measurements was also higher in symptomatic patients. The interventricular septum measured using TTE was thicker in patients with severe anginal symptoms. CONCLUSION: The frequency of anginal symptoms in patients with severe aortic valvular stenosis is higher than actual frequency of significant coronary stenosis on angiography. Angina is more common in a subgroup with coronary stenoses than in patients without coronary heart disease and the severity of anginal symptoms correlates with the number of coronary arteries involved. The severity of angina also correlates with the maximum pressure gradient across the aortic valve and the thickness of interventricular septum. In the study group hypercholesterolaemia, obesity and positive family history of IHD were more often found in patients with severe (CCS III/IV) symptoms.

Coronary atherosclerosis in patients with acquired valvular disease.

BACKGROUND: Coronary atherosclerosis often coexists with acquired valvular disorders. There is growing evidence in literature that these two conditions may have common aetiology. AIM: To assess the incidence of coronary atherosclerosis in patients with acquired valvular disorders and to compare clinical parameters as well as the prevalence of risk factors between patients with aortic and mitral valve diseases. METHODS: The study group consisted of 155 patients (101 males, 54 females, mean age 58.2+/-9.7 years) with acquired valvular disorder who between 2000 and 2002 underwent invasive cardiac evaluation in our department prior to planned cardiac surgery. Aortic stenosis was detected in 74 patients, aortic insufficiency -- in 26, mitral stenosis -- in 33, and mitral regurgitation -- in 14 subjects. All patients underwent clinical evaluation, echocardiography, coronary angiography and laboratory tests. RESULTS: Patients with aortic stenosis had similar prevalence of coronary atherosclerosis to patients with aortic insufficiency, and patients with mitral stenosis -- to patients with mitral regurgitation. When the two groups -- patients with aortic valve disease and patients with mitral valve disease were compared, significant coronary lesions were more often detected in patients with aortic valve disease (36% vs 12.8%, p<0.05). Also, patients with aortic valve disorder were older, predominantly of male gender, had more often angina but less often heart failure, and had higher total cholesterol level than patients with mitral valve disease. CONCLUSIONS: Significant coronary lesions are more frequently encountered in patients with aortic valve disorder than in those with mitral valve disease. A high prevalence of atherosclerotic risk factors in patients with aortic valve disease may suggest that this condition has similar aetiology to that of coronary artery disease.