Maryam Nabati1, Maryam Favaedi2. 1. Artesh Boulevard, Fatemeh Zahra Teaching Hospital, Department of Cardiology, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran. Electronic correspondence: Dr.mr.nabati@gmail.com. 2. Student Research Committee, Faculty of Medicine, Cardiovascular Research Center, Mazandaran University of Medical Sciences, Sari, Iran.
Abstract
BACKGROUND: Previous studies have reported an association between aortic valve sclerosis (AVS) and coronary atherosclerosis. However, the threshold of sclerosis used to identify high-risk patients has not yet been determined. METHODS: A total of 225 patients admitted with non- ST-elevation myocardial infarction (NSTEMI) or unstable angina was studied. Echocardiography was performed on all patients within 24 h of admission. Sclerosis scores were determined for each aortic cusp, and the average AVS score index (AVSSI) was calculated. The left ventricular ejection fraction (LVEF) and variables of left ventricular diastolic function and filling pressure, such as transmitral pulsed Doppler early diastolic velocities (E wave), early diastolic tissue Doppler mitral annular velocities (e'), and E/e', were also determined. These patients underwent coronary angiography, and SYNTAX scores were determined. RESULTS: Patients with an average AVSSI >1 were older, more hypertensive, and had higher rates of previous coronary artery bypass grafting. In addition, the prevalences of significant coronary artery disease (CAD) and three-vessel CAD were higher in these patients. Among the echocardiographic variables, LVEF and e' velocity were significantly lower and E/e' was significantly higher in patients with an AVSSI >1. These patients also had a higher prevalence of left ventricular hypertrophy, diastolic dysfunction, and ischemic mitral regurgitation than those with an average AVSSI ≤1. Regression analysis showed that AVS was independently associated with significant CAD and SYNTAX score. CONCLUSIONS: The average AVSSI may be a useful marker in the risk stratification of acute coronary syndrome patients, and is consistent with other high-risk echocardiographic variables, the presence of significant CAD, and more complex coronary artery lesions.
BACKGROUND: Previous studies have reported an association between aortic valve sclerosis (AVS) and coronary atherosclerosis. However, the threshold of sclerosis used to identify high-risk patients has not yet been determined. METHODS: A total of 225 patients admitted with non- ST-elevation myocardial infarction (NSTEMI) or unstable angina was studied. Echocardiography was performed on all patients within 24 h of admission. Sclerosis scores were determined for each aortic cusp, and the average AVS score index (AVSSI) was calculated. The left ventricular ejection fraction (LVEF) and variables of left ventricular diastolic function and filling pressure, such as transmitral pulsed Doppler early diastolic velocities (E wave), early diastolic tissue Doppler mitral annular velocities (e'), and E/e', were also determined. These patients underwent coronary angiography, and SYNTAX scores were determined. RESULTS:Patients with an average AVSSI >1 were older, more hypertensive, and had higher rates of previous coronary artery bypass grafting. In addition, the prevalences of significant coronary artery disease (CAD) and three-vessel CAD were higher in these patients. Among the echocardiographic variables, LVEF and e' velocity were significantly lower and E/e' was significantly higher in patients with an AVSSI >1. These patients also had a higher prevalence of left ventricular hypertrophy, diastolic dysfunction, and ischemic mitral regurgitation than those with an average AVSSI ≤1. Regression analysis showed that AVS was independently associated with significant CAD and SYNTAX score. CONCLUSIONS: The average AVSSI may be a useful marker in the risk stratification of acute coronary syndromepatients, and is consistent with other high-risk echocardiographic variables, the presence of significant CAD, and more complex coronary artery lesions.