Aortic stenosis, angina, and coronary artery disease. Interrelations.

Abstract

Subjects and methodsCardiac catheterization laboratory records were reviewed to identify all patients who had undergone both diagnostic catheterization for evaluation of aortic stenosis and coronary arteriography from the date it became routine policy in our hospitals to perform the latter procedure on all cases of left ventricular outflow obstruction before surgery. Since we were interested in examining only those patients with unequivocally severe aortic stenosis who were in an age range which could make concomitant coronary atherosclerosis a reasonable possibility, the following criteria were established for inclusion in the study: i) A systolic aortic valvular gradient of more than 5o mmHg (6.7 kPa) or calculated aortic valve area of less than 0.75 cm2, and 2) age over 35 years.Several patients included in the study had associated trivial aortic regurgitation or mitral valve disease, but in all cases aortic stenosis was clearly the dominant lesion. Aortic valve areas were calculated by the hydraulic formula of Gorlin and Gorlin (i95i), where applicable. Four patients were included in whom the aortic valve could not be traversed at the time of catheterization but in whom the presence of severe aortic stenosis was confirmed at surgery.Selective coronary arteriography was performed by the Sones' or Judkin's technique. In the majority of cases, the coronary arteries were opacified in at least two views, usually the left and right anterior oblique. An occasional case was retained in which a vessel was seen in one on 28 April 2019 by guest. Protected by copyright.

2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease

“…Among patients with AS, the prevalence of CAD is 40% to 50% in those with typical angina, an average 25% in those with atypical chest pain, and an average 20% in those without chest pain. [1003][1004][1005][1006][1007][1008][1009][1010] Even in patients less than 40 years old with no chest pain and no coronary risk factors, the prevalence of CAD is 0% to 5%. 998,1005,1011 In elderly patients (greater than 70 years old), angina is a strong determinant of CAD (sensitivity 78%, specificity 82%).…”

Report: Association of coronary artery disease and valvular heart disease in chile

“…In nations with a higher prevalence of CAD it may be reasonable to perform coronary angiography routinely from an earlier age. Indeed it has been recommended that patients with valvular heart disease over age 40 years undergo coronary angiography at the time of diagnostic cardiac catheterization (Baxter et al, 1978;Harris et al, 1975;Mandal et al, 1976;Roberts, 1982).…”

Pre‐infarction angina secondary to calcific aortic stenosis with bernheim's effect

“…It has been suggested that the resultant myocardial ischemia or infarction secondary to severe coronary artery disease leads to a fall in the systolic pressure gradient acros the aortic valve. Nevertheless, severe angina pectoris may occur in the abse nce of coronary artery disease in those who have a rugh degree of obstructive aortic valve disease and a valve area of 0.5 cm 2 or less (4,7,10,13). The c1irucal feature of crescendo angina in our patient led us to believe that significant coronary artery disease was at least partially responsible for generating the symptoms.…”