Original article
Aortic Valve Sclerosis: A Marker of Significant Obstructive Coronary Artery Disease in Patients with Chest Pain?

https://doi.org/10.1016/j.echo.2006.11.018Get rights and content

Background

Previous reports suggested a relationship between coronary artery disease (CAD) and aortic valve sclerosis (AVS). However, whether AVS can be used as a marker of obstructive CAD (obCAD) in patients with chest pain is unknown. We hypothesized that AVS is a predictive marker for obCAD in patients hospitalized for chest pain.

Methods

We studied 93 consecutive patients with chest pain undergoing coronary angiography. All had negative cardiac enzymes and no previous diagnosis of cardiac ischemic disease. AVS was detected by transthoracic echocardiography. Resting electrocardiography, left ventricular systolic function, wall-motion abnormalities, and stress test results were considered. We calculated the diagnostic value for obCAD of AVS, stress test, and combination of the two methods.

Results

ObCAD was present in 29 patients (31%). Patients with obCAD had a higher prevalence of AVS (38 vs 14%, P = .02) and positive stress test (67 vs 28%, P = .02). The odds ratio for obCAD in the presence of AVS was 3.7 (95% confidence interval 1.3-10.4, P = .01). AVS (P = .01) and a positive stress test (P = .002) were independent predictors for obCAD at the multivariate analysis. AVS had sensitivity of 38% and specificity of 86%. Stress test had sensitivity of 67% and specificity of 72%. When echocardiographic detection of AVS was combined with stress test, the sensitivity and negative predictive value improved to 93% and 96%, respectively.

Conclusions

AVS is an independent predictor for obCAD in patients with chest pain, thus, it should be considered in the risk stratification of these patients.

Section snippets

Study Group

This investigation was based on a retrospective review of patients selected from our echocardiographic electronic database. The study population consisted of 93 consecutive patients who met all the following inclusion criteria: (1) had been hospitalized in our department of cardiology for suggested CAD-related chest pain; (2) underwent transthoracic echocardiography and coronary angiography; (3) no previous diagnosis of cardiac ischemic disease; (4) no positive cardiac enzymes at admission to

Results

The baseline characteristics of the patients with chest pain undergoing coronary angiography are listed in Table 1. The obCAD group included 29 patients (22 men and 7 women; mean age 59 ± 11 years) and the non-obCAD group included 64 patients (33 men and 31 women; mean age 57 ± 10 years). There was a higher proportion of male patients in the obCAD group than in the non-obCAD group (76 vs 51%, P < .05). Patients with obCAD had a higher prevalence of positive reply at the stress test (67 vs 28%, P

Discussion

In this study we found that AVS is a strong independent predictor of obCAD in patients with chest pain and normal cardiac enzymes undergoing coronary angiography.

Concerning the report by Otto et al3 of a higher rate of ischemic events and increased cardiovascular mortality in patients with AVS, Carabello4 wondered whether the clinical suggestion of AVS by simple auscultation of a systolic ejection murmur and subsequent echocardiography could be part of the standard screening procedure for CAD.

References (34)

Cited by (22)

  • Cardiovascular morbidity and mortality in patients with aortic valve sclerosis: A systematic review and meta-analysis

    2018, International Journal of Cardiology
    Citation Excerpt :

    Moreover, after excluding studies potentially including the same population as other included studies [10,17,20,28], similar results were obtained (OR: 1.90, 95% CI: 1.56–2.31; I2: 78.7%, p < 0.001). Interestingly, a significant difference between AVSc patients and controls was confirmed both in the 11 studies [4,6,10–12,23–26,30,33] specifically evaluating myocardial infarction as outcome (OR: 2.13, 95% CI: 1.57–2.88, I2: 89.3%, p < 0.001) and in the 14 studies [8,14,16–20,28,29,31,32,34–36] defining CAD as the presence of angiographically obstructive coronary artery stenosis (OR: 2.41, 95% CI: 1.85–3.14, I2: 36.3, p = 0.086). Similar results were also confirmed after excluding the 11 studies [4,13,15,17–19,28,30,31,33,36] including controls who were not age-matched with AVSc patients (OR: 1.94, 95% CI: 1.50–2.50).

  • Aortic valve sclerosis and clinical outcomes: Moving toward a definition

    2011, American Journal of Medicine
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    Utilization of the term “aortic valve sclerosis” varied widely among readers, from 3% to 36%. In the absence of a strict definition for aortic valve sclerosis and in recognition of previously reported associations of aortic valve sclerosis with cardiovascular death,6 myocardial infarction,1,6,18 and obstructive coronary artery disease,3 further insight into characteristics that influence the reporting of aortic valve appearance are needed. The Table describes the echocardiographic criteria used for defining aortic valve sclerosis in studies assessing the association of aortic valve sclerosis with outcomes.

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