Aim: The aim of the study was to analyze the factors contributing to the development of anginal pain common in patients with aortic valvular stenosis (SOAS).
Methods: The study included 74 consecutive patients, aged 60,5 (+/- 10,7), with severe acquired valvular aortic stenosis (resting maximum systolic pressure gradient above 50 mm Hg) who were referred for evaluation prior to elective cardiac surgery. The history of angina and its severity according to CCS classification and of common atherosclerosis risk factors including: hypertension, hyperlipidaemia, smoking, diabetes mellitus and family history was taken. The laboratory tests included: lipidogram, white blood count and serum creatinine. The transthoracic echocardiography (TEE) date were collected: LVEDd, IVSDd, LVPWDd, LAd, EF, SF, SV, EDV, ESV, maximum systolic transvalvular pressure gradient and degree of aortic insufficiency. Coronary angiography was then performed. The presence of severe atherosclerosis was defined as more than 50% stenosis of one of three main coronary arteries: right, anterior descending or circumflex artery. Haemodynamic protocol involved LVEDP, PCWP, CO, PASP, aortic pressure gradient and aortic insufficiency evaluation.
Results: Patients with severe anginal symptoms (CCS III/IV) were older, had higher LDL cholesterol and triglycerides concentrations, more often had obesity and positive family history of ischemic heart disease than patients with mild (CCS I/II) or without symptoms. They had also higher number of vessels with significant stenosis which most frequently presented in left anterior descending artery. The maximum systolic pressure gradient according to TTE as well as to invasive measurements was also higher in symptomatic patients. The interventricular septum measured using TTE was thicker in patients with severe anginal symptoms.
Conclusion: The frequency of anginal symptoms in patients with severe aortic valvular stenosis is higher than actual frequency of significant coronary stenosis on angiography. Angina is more common in a subgroup with coronary stenoses than in patients without coronary heart disease and the severity of anginal symptoms correlates with the number of coronary arteries involved. The severity of angina also correlates with the maximum pressure gradient across the aortic valve and the thickness of interventricular septum. In the study group hypercholesterolaemia, obesity and positive family history of IHD were more often found in patients with severe (CCS III/IV) symptoms.