Aortic valve sclerosis: a marker of significant obstructive coronary artery disease in patients with chest pain?
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.
Conte
Luca
L
Section of Cardiology, Department of Biochemical and Surgical Sciences, University of Verona, Verona, Italy. lucaconte@yahoo.com <lucaconte@yahoo.com>
Rossi
Andrea
A
Cicoira
Mariantonietta
M
Bonapace
Stefano
S
Amado
Eleas Alejandra
EA
Golia
Giorgio
G
Zardini
Piero
P
Vassanelli
Corrado
C
D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000473:pathology*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000209:etiology*; D002637:Chest Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D023921:Coronary Stenosis / Q000150:complications* / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012598:Sclerosis; D012680:Sensitivity and Specificity; D014463:Ultrasonography