Association of aortic valve sclerosis and coronary artery disease in patients with severe nonischemic mitral regurgitation

Abstract

Background: The presence of aortic valve sclerosis accounts for a higher rate of ischemic events and increased cardiovascular mortality. It may reflect coronary artery disease (CAD) because of a shared pathologic background. Hypothesis: We aimed to analyze whether the presence of aortic valve sclerosis might help in identifying patients with coronary atherosclerosis among those with severe nonischemic mitral regurgitation (MR), who undergo coronary angiography before surgery for screening, and not because of suspected ischemic heart disease. Methods: In all, 84 patients (mean age 64 ± 9 years; 71% men) with mitral valve prolapse and severe regurgitation underwent echocardiography and coronary angiography. Aortic valve sclerosis was defined as focal areas of increased echogenicity and thickening of the leaflets without restriction of leaflet motion on echocardiography. Coronary artery disease was defined by the presence/absence of atherosclerotic plaques, independent of the degree of stenosis. Results: Coronary artery disease was diagnosed in 47.6% of patients with and 15.8% of those without aortic valve sclerosis (p = 0.008). On logistic regression analysis, the presence of aortic valve sclerosis predicted CAD (odds ratio 3.3,95% confidence interval 1.03‐10.5; p = 0.04) independent of age. In female patients, the risk ratio for CAD in the presence of aortic valve sclerosis was 9. Conclusions: Coronary artery atherosclerosis and aortic valve sclerosis are closely associated in patients with severe nonischemic MR.

Aortic and Mitral Annular Calcifications Are Predictive of All-Cause and Cardiovascular Mortality in Patients With Type 2 Diabetes

“…It is known that there are similarities in the histopathologic lesions of AVS, MAC, and coronary atherosclerosis and that these three diseases share multiple CVD risk factors (e.g., hypertension, smoking, dyslipidemia, and diabetes) and common pathophysiologic mechanisms ( 1 – 3 , 18 , 21 ). More recent studies suggested that AVS and MAC are not only associated with coronary atherosclerosis but also with atherosclerosis in other vascular beds ( 21 – 25 ). However, since in our study the HVC score strongly predicted CVD mortality independently of traditional CVD risk factors and other potential confounders, it is also possible to speculate that AVS and MAC, singly or in combination, reflect not only the burden of systemic atherosclerosis ( 1 – 3 , 21 , 26 , 27 ) but also the presence of other underlying conditions, which may predispose patients to active and accelerated atherosclerosis, such as systemic chronic inflammation ( 21 , 28 ), platelet aggregation abnormalities ( 21 , 29 ), and genetic predisposition ( 30 ).…”

Prognóstico da esclerose valvar aórtica na mortalidade cardíaca de pacientes atendidos no instituto de cardiologia do Rio Grande do Sul

“…Literature data on the association of aortic valve sclerosis with coronary artery disease or coronary ischemic events are controversial, ranging from reports suggesting a 50% increase in cardiovascular mortality to those demonstrating an association with coronary artery disease to recommendations for secondary prevention with statins or angiotensin-converting enzymes in AVS patients [29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] . At the other extreme, Chandra and colleagues found no association between aortic valve sclerosis and the all-cause or cardiovascular mortality endpoint 48 , and Tolstrup et al found no association between aortic valve sclerosis and coronary artery disease 49 .…”