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Dolmaci OB, Hilhorst TL, Malekzadeh A, Mertens BJA, Klautz RJM, Poelmann RE, Grewal N. The Prevalence of Coronary Artery Disease in Bicuspid Aortic Valve Patients: An Overview of the Literature. AORTA (STAMFORD, CONN.) 2024. [PMID: 38698623 DOI: 10.1055/s-0044-1785190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
The prevalence of coronary artery disease (CAD) in bicuspid aortic valve (BAV) patients is a debatable topic. Several studies have indicated that BAV patients have a lower prevalence of CAD compared with patients with a tricuspid aortic valve (TAV), but the effects of age and gender have not always been considered. This systematic review provides an overview of articles which report on CAD in BAV and TAV patients. Searches were executed in April 2021 and January 2022 according to the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analyses) guidelines in three online databases: Medline, Embase, and Scopus. Screening and data extraction was done by two investigators separately. Primary and secondary outcomes were compared between BAV and TAV patients; a fixed effects model was used for correcting on confounders. Literature search yielded 1,529 articles with 44 being eligible for inclusion. BAV patients were younger (56.4 ± 8.3 years) than TAV patients (64 ± 10.3 years, p < 0.001). All CAD risk factors and CAD were more prevalent in TAV patients. No significant difference remained after correcting for age and gender as confounders. BAV patients have a lower prevalence of CAD and CAD risk factors compared with TAV patients. However, when the age differences between both groups are considered in the analyses, a similar prevalence of both CAD and CAD risk factors is found.
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Affiliation(s)
- Onur B Dolmaci
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Tijmen L Hilhorst
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Arjan Malekzadeh
- Medical Library, Amsterdam University Medical Center, Location University of Amsterdam, Amsterdam, Netherlands
| | - Bart J A Mertens
- Department of Statistics, Leiden University Medical Center, Leiden, Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Robert E Poelmann
- Institute of Biology, Leiden University, Sylvius Laboratory, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Nimrat Grewal
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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Shafi S, Aouabdi S, Taher ZA, Alghamdi AE, Ahmed MA, Ahmed FA, Alghamdi S, Haneef A. The Prevalence and Predictors of Atherosclerotic Coronary Artery Disease in Rheumatic and Non-rheumatic Valvular Heart Disease Patients. Cureus 2024; 16:e57317. [PMID: 38690477 PMCID: PMC11060012 DOI: 10.7759/cureus.57317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES The paradox of concurrent coronary artery disease (CAD) among patients with rheumatic and non-rheumatic valvular heart disease (RVHD; non-RVHD) is unclear. We aimed to evaluate the impact of the RVHD and non-RVHD on the prevalence of CAD and various risk factors, assess the number of diseased coronaries, clinical profile and the possible predictors of CAD in these patients, which may clarify the paradox and provide an insight for the prevention of CAD. METHODS The records of 106 valvular heart disease patients who had undergone valve replacement surgery at the King Faisal Cardiac Centre from January 2014 to October 2019 were evaluated. The clinical data and established risk factors were compared and logistic regression analyses were performed to identify plausible predictors of CAD. RESULTS Transthoracic echocardiographic diagnosis of 106 patients confirmed, 43 had RVHD (56.4 ± 8 years), of whom six (13.9%) had CAD with the highest mitral valve regurgitation (p < 0.01), and 63 had non-RVHD (60.0 ± 12 years). Of these, 31 patients showed the highest CAD (49.2%). Single- and triple-vessel disease was most common in RVHD and non-RVHD patients with concurrent CAD (33.3%; 41.9%, respectively), while non-RVHD patients also had quadruple vessel disease. The mean age of the RVHD and non-RVHD patients with coexisting CAD was significantly higher (66.7 ± 5; 66.7 ± 8 years) than those without CAD (46.1 ± 12.0; 54.7 ± 20, respectively). RVHD patients showed a significantly lower prevalence of diabetes, dyslipidaemia, hypertension, inflammatory cells, hepatorenal function markers, ejection fraction, and regional wall motion abnormality compared to RVHD patients with coexisting CAD (p < 0.01). Bivariate analysis indicated white blood cells, monocytes, neutrophils, gamma-glutamyl-transferase (GGT), bilirubin and blood urea nitrogen (BUN) to be significantly lower in RVHD patients. Predictors of high risk of CAD were BUN and hyperlipidaemia for RVHD and BUN, creatinine and GGT for non-RVHD patients. CONCLUSIONS The prevalence of CAD in Saudi RVHD patients was significantly lower than in the Western countries, whereas non-RVHD was higher. The low prevalence may partly be attributed to age, reduced mitral regurgitation, and low frequency of risk and inflammatory factors.
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Affiliation(s)
- Shahida Shafi
- Department of Cardiology, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Sihem Aouabdi
- Department of Regenerative Medicine, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Ziad A Taher
- Department of Medicine, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Department of Medicine, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Jeddah, SAU
| | | | - Mohammed A Ahmed
- Department of Emergency Medicine, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Fatima A Ahmed
- Department of Cardiology, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Jeddah, SAU
| | - Suliman Alghamdi
- Department of Radiation Oncology, Ministry of National Guard Health Affairs, King Abdulaziz Medical City, Jeddah, SAU
| | - Ali Haneef
- Department of Cardiac Surgery, King Faisal Cardiac Center, King Abdulaziz Medical City, Jeddah, SAU
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Karak A, Deb N, Khanra D, Guha S, Mukherjee A. Coronary artery disease in patients with rheumatic valvular heart disease- An analysis from eastern India. Indian Heart J 2024; 76:48-50. [PMID: 38043642 PMCID: PMC10943554 DOI: 10.1016/j.ihj.2023.11.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023] Open
Abstract
INTRODUCTION There is insufficient information on the angiographic characteristics of individuals with rheumatic valvular heart disease (VHD) from eastern India. The objective of this research is to gather important data in this area to aid the best surgical outcomes for patients with rheumatic VHD. MATERIALS AND METHODS 978 consecutive patients with rheumatic VHD, scheduled for surgical intervention, were recruited. RESULT AND CONCLUSION Mitral valve involvement was observed in 66.1 %, aortic valve in 7.3 % and both valves in 26.6 %. Patients with CAD had significantly higher proportions of severe aortic stenosis (AS). Therefore, addressing the risk factors for CAD is crucial in patients with rheumatic VHD.
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Affiliation(s)
| | - Novonil Deb
- North Bengal Medical College and Hospital, Darjeeling, India.
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Hoang SV, Tran HPN, Nguyen KM, Tran PT, Huynh KLA, Nguyen NT. Prediction of obstructive coronary artery disease in patients undergoing heart valve surgery: A cross-sectional study in a tertiary care hospital. J Cardiovasc Thorac Res 2023; 15:57-64. [PMID: 37342658 PMCID: PMC10278189 DOI: 10.34172/jcvtr.2023.30557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 03/03/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction: Estimating the probability of obstructive coronary artery disease in patients undergoing noncoronary cardiac surgery should be considered compulsory. Our study sought to evaluate the prevalence of obstructive coronary artery disease in patients undergoing valvular heart surgery and to utilize predictive methodology of concomitant obstructive coronary artery disease in these patients. Methods: The retrospective study cohort was derived from a tertiary care hospital registry of patients undergoing coronary angiogram prior to valvular heart operations. Decision tree, logistic regression, and support vector machine models were built to predict the probability of the appearance of obstructive coronary artery disease. A total of 367 patients from 2016 to 2019 were analyzed. Results: The mean age of the study population was 57.3±9.3 years, 45.2% of the patients were male. Of 367 patients, 76 (21%) patients had obstructive coronary artery disease. The decision tree, logistics regression, and support vector machine models had an area under the curve of 72% (95% CI: 62% - 81%), 67% (95% CI: 56% - 77%), and 78% (95% CI: 68% - 87%), respectively. Multivariate analysis indicated that hypertension (OR 1.98; P=0.032), diabetes (OR 2.32; P=0.040), age (OR 1.05; P=0.006), and typical angina (OR 5.46; P<0.001) had significant role in predicting the presence of obstructive coronary artery disease. Conclusion: Our study revealed that approximately one-fifth of patients who underwent valvular heart surgery had concomitant obstructive coronary artery disease. The support vector machine model showed the highest accuracy compared to the other model.
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Affiliation(s)
- Sy Van Hoang
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
- Department of Cardiology, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Hai Phuong Nguyen Tran
- Department of Cardiology Intervention, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Kha Minh Nguyen
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City 700000, Vietnam
- Department of Cardiology, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
| | - Phong Thanh Tran
- Department of Cardiology, Can Tho Central General Hospital, Can Tho City 900000, Vietnam
| | - Khoa Le Anh Huynh
- Department of Biostatistics, Virginia Commonwealth University School of Medicine, Virginia, USA
| | - Nghia Thuong Nguyen
- Department of Cardiology Intervention, Cho Ray Hospital, Ho Chi Minh City 700000, Vietnam
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Matta A, Moussallem N. Coronary artery disease is associated with valvular heart disease, but could it Be a predictive factor? Indian Heart J 2019; 71:284-287. [PMID: 31543203 PMCID: PMC6796620 DOI: 10.1016/j.ihj.2019.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/29/2019] [Accepted: 07/02/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study was conducted to evaluate the prevalence of significant coronary artery disease (CAD) in patients with severe valvular heart disease (VHD) and the association between these two cardiac entities. Our research aims to introduce the theory of a possible causal relationship. METHODS A retrospective study was conducted on 1308 consecutive patients who underwent surgery for severe VHD in the cardiovascular department of Notre-Dame de Secours University Hospital (NDSUH) between December 2000 and December 2016. According to transthoracic echocardiography, patients were divided into 4 groups: patients with severe aortic stenosis (AS), patients with severe aortic regurgitation (AR), patients with severe mitral stenosis (MS), and patients with severe mitral regurgitation (MR). Preoperative coronary angiographies were reviewed for the presence or the absence of significant CAD (≥50% luminal stenosis). Chi-square test and 2 × 2 tables were used. RESULTS Of the 1308 patients with severe VHD, 1002 patients had isolated aortic valve disease, 240 patients had isolated mitral valve disease, and 66 patients had combined aortomitral valve disease. CAD was detected in 27.75% of all patients with severe VHD, in 32% of patients with isolated aortic valve disease, and in 15% of patients with isolated mitral valve disease. Statistical analysis showed a higher prevalence in patients with severe aortic valve stenosis and a significant relationship between CAD and aortic valve disease, mainly severe AS (p < 0.0001). CONCLUSION The prevalence of CAD in patients with VHD is 27.75%, and it correlates significantly with aortic valve disease, in particular with severe AS. Future large studies are needed to evaluate the possible causal relationship.
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Affiliation(s)
- Anthony Matta
- Faculty of Medicine, Holy Spirit University of Kaslik, Kaslik, Lebanon.
| | - Nicolas Moussallem
- Faculty of Medicine, Holy Spirit University of Kaslik, Kaslik, Lebanon; Past President of Lebanese Society of Cardiology; Fellow of European Society of Cardiology and American College of Cardiology
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Sharma K, Singhal R, Jadhav N, Shah K, Patil S. Evaluation of SERENE-CAG score for assessing suitability for coronary angiography preoperatively in patients undergoing valve replacement surgery. Indian Heart J 2019; 70 Suppl 3:S189-S193. [PMID: 30595255 PMCID: PMC6310738 DOI: 10.1016/j.ihj.2018.10.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/07/2018] [Accepted: 10/10/2018] [Indexed: 12/01/2022] Open
Abstract
AIMS The aim of this study was to identify better selection criteria for subjecting patients of rheumatic heart disease (RHD) to preoperative coronary angiography (CAG) based on indigenous scoring system (SERENE-CAG [Selecting Patients Of Rheumatic Heart Disease Undergoing Valve Surgery For Presurgical Coronary Angiography]). METHODS This prospective study included all consecutive 798 patients of RHD patients undergoing preoperative CAG from January 2016 to December 2017 over a duration of 2 years. Multivariate logistic regression analysis was performed with the presence of significant CAD [coronary artery disease] as the dependent variable with traditional risk factors of CAD. An additive score was developed using coefficient derived logistic regression for those variables that were significant. Receiver-operator curve analysis was performed to assess the ability of this score to predict diseased vs normal CAG. RESULTS A total of 798 patients had a mean age of 51.7 ± 12.5 years. Significant CAD requiring revascularization along with valve surgery was identified in 50 (6.26%) patients. Male gender was found as significant predictors of CAD with odds ratio 2.6. A SERENE CAG SCORE of >2.8 resulted in sensitivity of 80% and specificity of 36.9% of predicting CAD in RHD patients with positive and negative predictive value of 7.8% and 96.5%, respectively. CONCLUSION The prevalence of CAD in RHD patients is low. Patient risk can be minimized by exploring noninvasive modalities for screening of CAD and by more appropriate selection of patients for invasive coronary angiogram. Using threshold SERENE-CAG score of >2.8 would result in deferring 34.6% of normal angiograms.
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Affiliation(s)
- Kamal Sharma
- Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus, Ahmedabad- 380016, Gujarat, India
| | - Roopesh Singhal
- Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus, Ahmedabad- 380016, Gujarat, India.
| | - Nikhil Jadhav
- Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus, Ahmedabad- 380016, Gujarat, India
| | - Komal Shah
- Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus, Ahmedabad- 380016, Gujarat, India
| | - Sachin Patil
- Department of Cardiology, U. N. Mehta Institute of Cardiology and Research Centre, Civil Hospital Campus, Ahmedabad- 380016, Gujarat, India
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Chadha DS, Malani SK, Bharadwaj P, Karthikeyan G, Hasija PK. Risk factors for degenerative aortic valve disease in India: A case control study. Med J Armed Forces India 2018; 74:33-37. [PMID: 29386729 DOI: 10.1016/j.mjafi.2017.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 03/09/2017] [Indexed: 02/03/2023] Open
Abstract
Background Degenerative aortic valve disease often co-exists with coronary artery disease (CAD) and studies done in western populations have shown that it shares the same risk factors which cause CAD. However little is known in this context among Asian Indians. The current study looks into the risk factors of degenerative aortic valve disease in Asian Indian population. Methods Ninety-one consecutive patients with severe aortic stenosis (AS) reporting for left heart catheterization prior to valve replacement surgery at a tertiary care centre were recruited for the study. They were compared with age and sex matched controls selected from a database of 3200 patients referred for elective diagnostic left heart catheterization for suspected CAD. Following traditional cardiovascular risk factors were assessed in all patients: age, gender, family history of CAD, smoking history, presence of diabetes, hypertension and dyslipidemia. Results The mean age of the study population was 57.8 ± 8.2 years (range, 40-80 years). Smoking, family history of CAD and hypercholesterolemia were significantly more prevalent in patients with degenerative AS compared to those with normal valves. No significant difference was noted in the presence of diabetes mellitus. On multivariate logistic regression, family history of premature CAD (OR 3.68; CI 1.38-9.78) smoking history (OR, 2.56; CI, 1.21-5.39), and raised LDL levels (OR, 5.55; CI, 2.63-11.69) were independently associated with the aortic stenosis patient cohort. Conclusions The study showed a significant association of cardiovascular risk factors with aortic stenosis independent of age and gender in Asian Indian patients.
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Affiliation(s)
- D S Chadha
- Senior Advisor (Medicine & Cardiology), Command Hospital (Air Force), Bangalore, India
| | - S K Malani
- Consultant (Medicine & Cardiology), Command Hospital (Central Command), Lucknow, UP, India
| | - P Bharadwaj
- Consultant (Medicine & Cardiology), Military Hospital (Cardio Thoracic Centre), Pune 411040, India
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Cazelli JG, Camargo GC, Kruczan DD, Weksler C, Felipe AR, Gottlieb I. Prevalence and Prediction of Obstructive Coronary Artery Disease in Patients Undergoing Primary Heart Valve Surgery. Arq Bras Cardiol 2017; 109:348-356. [PMID: 28977048 PMCID: PMC5644215 DOI: 10.5935/abc.20170135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/13/2017] [Indexed: 11/20/2022] Open
Abstract
Background The prevalence of coronary artery disease (CAD) in valvular patients is
similar to that of the general population, with the usual association with
traditional risk factors. Nevertheless, the search for obstructive CAD is
more aggressive in the preoperative period of patients with valvular heart
disease, resulting in the indication of invasive coronary angiography (ICA)
to almost all adult patients, because it is believed that coronary artery
bypass surgery should be associated with valve replacement. Objectives To evaluate the prevalence of obstructive CAD and factors associated with it
in adult candidates for primary heart valve surgery between 2001 and 2014 at
the National Institute of Cardiology (INC) and, thus, derive and validate a
predictive obstructive CAD score. Methods Cross-sectional study evaluating 2898 patients with indication for heart
surgery of any etiology. Of those, 712 patients, who had valvular heart
disease and underwent ICA in the 12 months prior to surgery, were included.
The P value < 0.05 was adopted as statistical significance. Results The prevalence of obstructive CAD was 20%. A predictive model of obstructive
CAD was created from multivariate logistic regression, using the variables
age, chest pain, family history of CAD, systemic arterial hypertension,
diabetes mellitus, dyslipidemia, smoking, and male gender. The model showed
excellent correlation and calibration (R² = 0.98), as well as excellent
accuracy (ROC of 0.848; 95%CI: 0.817-0.879) and validation (ROC of 0.877;
95%CI: 0.830 - 0.923) in different valve populations. Conclusions Obstructive CAD can be estimated from clinical data of adult candidates for
valve repair surgery, using a simple, accurate and validated score, easy to
apply in clinical practice, which may contribute to changes in the
preoperative strategy of acquired heart valve surgery in patients with a
lower probability of obstructive disease.
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Affiliation(s)
| | | | - Dany David Kruczan
- Instituto Estadual de Cardiologia Aloysio de Castro, Rio de Janeiro, RJ, Brazil
| | - Clara Weksler
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brazil
| | | | - Ilan Gottlieb
- Instituto Nacional de Cardiologia, Rio de Janeiro, RJ, Brazil
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