The comparative value of the aortic atherosclerosis and the coronary flow velocity reserve evaluated by stress transesophageal echocardiography in the prediction of patients with aortic stenosis with coronary artery disease.
BACKGROUND
The present study was conducted to examine whether it is possible to differentiate patients with aortic stenosis (AOS) with or without significant stenosis of the left anterior descending coronary artery (LAD) on the basis of the age, gender, hypertension, diabetes mellitus, hypercholesterolemia, the coronary flow velocity reserve (CFVR) and the grade of aortic atherosclerosis (AA) evaluated by TEE in the course of the same semi-invasive examination.


METHODS
Thirty-nine consecutive AOS patients who had undergone coronary angiography were examined by dipyridamole stress TEE to assess the CFVR. From this patient population, 21 AOS patients with anatomically normal coronary arteries (group 1), and 18 AOS patients with > 75% stenosis of the LAD (group 2) were selected for the present study. The CFVR was calculated as the ratio of the average peak diastolic flow velocity (APV) during hyperemia to the resting APV. The grade of AA in the descending aorta was determined by means of the same TEE examination.


RESULTS
The demographic, clinical and transthoracic echocardiographic data, the coronary flow velocities and the CFVRs were similar in the two patient groups. Only the grade of AA (ROC area, 73%, p < 0.02) appears useful for the distinction of AOS patients with or without significant LAD stenosis.


CONCLUSIONS
These results demonstrate that only the grade of AA furnishes additional help in the prediction of AOS patients with severe LAD disease. CFVR has no any diagnostic power in the differentiation of AOS patients with or without significant LAD stenosis.
Nemes
Attila
A
2nd Department of Medicine and Cardiology Center, Medical Faculty, Albert Szent-Györgyi Medical and Pharmaceutical Center, University of Szeged, Szeged, Hungary. nemes@in2nd.szote.u-szeged.hu
Forster
Tamás
T
Thury
Attila
A
Kovács
Zsolt
Z
Boda
Krisztina
K
Csanády
Miklós
M
D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001024:Aortic Valve Stenosis / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D001783:Blood Flow Velocity / Q000502:physiology*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D003326:Coronary Circulation / Q000502:physiology; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004176:Dipyridamole; D004452:Echocardiography; D025401:Echocardiography, Stress; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D012372:ROC Curve; D012307:Risk Factors; D012720:Severity of Illness Index; D014665:Vasodilator Agents; D017725:Ventricular Pressure / Q000502:physiology
D014665:Vasodilator Agents; D004176:Dipyridamole