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      Relationship between Aortic Valve Sclerosis and the Extent of Coronary Artery Disease in Patients Undergoing Diagnostic Coronary Angiography

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          Abstract

          Background: Aortic valve sclerosis (AVS) is considered to be a manifestation of coronary atherosclerosis. Recent studies demonstrated an association between AVS and significant coronary artery disease (CAD). Aim: We sought to determine the association between AVS and the extent of coronary atherosclerosis by means of the Gensini score system, which was calculated to yield a measure of the extent and severity of coronary atherosclerosis in patients referred for coronary angiography. Methods: A total of 160 consecutive patients referred for coronary angiography were subjected to echocardiography for screening of AVS and coronary risk assessment. Absence (group 1, n = 110) and presence of AVS (Group 2, n = 50) was established. The cardiac risk factors considered in this study were age, gender, family history of CAD, diabetes mellitus, hypertension, hypercholesterolemia and history of smoking. The body mass index was also measured. Atherosclerotic plaque burden was determined using the Gensini score. Significant CAD was defined as >50% reduction in the internal diameter of at least one coronary artery. Multivessel coronary disease was based on the presence of 2- or 3-vessel disease. Results: The AVS patients had a higher rate of 3-vessel disease (AVS group vs. non AVS: 40 vs. 13.6%; p < 0.001). No significant correlations were found between AVS and 1- and 2-vessel disease. Individuals with AVS were found to have a higher Gensini score (40.7 ± 38.05 vs. 18 ± 16.4; p < 0.001). Multivariate analysis identified age (p < 0.001), male sex (p = 0.01), triglycerides (p = 0.02), LDL cholesterol (p = 0.001) and Gensini score (p = 0.003) as independent predictors of AVS. Conclusion: AVS is strongly interrelated with the coronary angiographic Gensini score. Echocardiographic detection of AVS in patients undergoing coronary angiography can provide a new surrogate marker of the extent of coronary atherosclerosis.

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          Most cited references 10

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          Clinical Factors Associated With Calcific Aortic Valve Disease fn1fn1This study was supported in part by Contracts NO1-HC85079 through HC-850086 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.

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            Aortic valve sclerosis is associated with systemic endothelial dysfunction.

            We sought to examine the association between aortic valve sclerosis (AVS) and systemic endothelial manifestations of the atherosclerotic process. Clinical and experimental studies suggest that AVS is a manifestation of the atherosclerotic process. Systemic endothelial dysfunction is an early sign of the atherosclerotic process and can be assessed by ultrasonography of the brachial artery. A total of 102 in-hospital patients (76 men; mean age 63.5 +/- 9.7 years) referred to the stress echocardiography laboratory underwent: 1) transthoracic echocardiography, with specific assessment of AVS (thickened valve leaflets with a transaortic flow velocity <2.5 m/s); 2) stress echocardiography; 3) coronary angiography, with evaluation of the Duke score (from 0 [normal] to 100 [most severe disease]); and 4) an endothelial function study, with assessment of endothelium-dependent, post-ischemic, flow-mediated dilation (FMD). Aortic valve sclerosis was present in 35 patients (group I) and absent in 67 (group II). Groups I and II were similar in terms of the frequency of stress-induced wall motion abnormalities (35.3% vs. 19.4%, p = NS) and the angiographic Duke score (33.8 +/- 28.6 vs. 35.2 +/- 29.1, p = NS). Patients with AVS showed a markedly lower FMD than those without AVS (2.2 +/- 3.5% vs. 5.3 +/- 5.3%, p < 0.01). On multivariate analysis, only FMD was highly predictive of AVS, with an odds ratio of 1.18 for each percent decrease in FMD (95% confidence interval 1.05 to 1.32; p = 0.01). Aortic valve stenosis is associated with systemic endothelial dysfunction. This observation may provide a mechanistic insight into the emerging association between AVS and cardiovascular events.
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              Aortic valve sclerosis and aortic atherosclerosis: different manifestations of the same disease?

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                Author and article information

                Journal
                CRD
                Cardiology
                10.1159/issn.0008-6312
                Cardiology
                S. Karger AG
                0008-6312
                1421-9751
                2006
                November 2006
                15 November 2006
                : 106
                : 4
                : 277-282
                Affiliations
                Departments of Cardiology, aUniversity of Gaziantep School of Medicine, and bAmerican Hospital, Gaziantep, Turkey
                Article
                93491 Cardiology 2006;106:277–282
                10.1159/000093491
                16733352
                © 2006 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Figures: 1, Tables: 2, References: 14, Pages: 6
                Categories
                Original Research

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