title: Prevalence and clinical impact of left coronary dominance in patients with aortic stenosis.
abstract: OBJECTIVE
  Left coronary dominance may be more prevalent in patients with valvular aortic stenosis (AS). A cohort study was conducted to: (i) determine the prevalence of coronary left dominance in patients with AS; (ii) assess if a possible higher prevalence of left dominance is confined to patients with bicuspid aortic valve; (iii) examine if left dominance is a risk factor for the progression of AS, independent of established risk factors; and (iv) assess in-hospital clinical outcome following valve replacement according to the coronary dominance pattern.
  
  
  METHODS
  The prevalence of left coronary dominance was analyzed in 721 patients with severe isolated AS, and compared to a control cohort of 6,990 patients without AS. The clinical data and short-term outcome following valve replacement were assessed according to the coronary dominance pattern.
  
  
  RESULTS
  Left coronary dominance was significantly more prevalent in patients with AS compared to those without AS (13.7% versus 10.2%, p = 0.003), and a pattern of right coronary dominance was less frequent in patients with AS (66.9% versus 71.6%, p = 0.008), irrespective of the presence of a bicuspid or tricuspid valve. Left coronary dominance was not an independent predictor of younger age at the time of valve replacement. There were no differences for in-hospital mortality and rates of myocardial infarction between coronary dominance types.
  
  
  CONCLUSIONS
  Although left coronary dominance is more prevalent in patients with AS, it is not a risk factor for disease progression, and is not associated with short-term adverse outcome following valve replacement.
authors.affiliation: Department of Internal Medicine/Cardiology, University of Leipzig Heart Center, Leipzig, Germany. stdesch@web.de
authors.forename: Steffen
authors.initials: S
authors.lastname: Desch
authors.forename: Christina
authors.initials: C
authors.lastname: Harzendorf
authors.forename: Suzanne
authors.initials: S
authors.lastname: de Waha
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.forename: Friedrich-Wilhelm
authors.initials: FW
authors.lastname: Mohr
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000002:abnormalities / Q000503:physiopathology* / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000503:physiopathology* / Q000601:surgery; D018450:Disease Progression; D005260:Female; D007839:Functional Laterality; D005858:Germany; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome