title: Clinical factors associated with classical symptoms of aortic valve stenosis.
abstract: OBJECTIVE
  The recognition of clinical symptoms is critical to a therapeutic strategy for aortic valve stenosis (AS). It was hypothesized that AS symptoms might have multiple causes; hence, a study was conducted to investigate the factors that separately influence the classic symptoms of dyspnea, angina and syncope in AS.
  
  
  METHODS
  The medical records of 170 consecutive patients with AS (> or = moderate grade) were reviewed. A multivariate logistic regression analysis was used to evaluate the hemodynamic and clinical factors that separately influence the development of three clinical symptoms: dyspnea (defined as NYHA class > or = 2), angina, and syncope.
  
  
  RESULTS
  The most common symptom was dyspnea (47.1%), followed by angina (12.4%) and syncope (4.7%). The factors associated with dyspnea were a higher e' ratio (p = 0.04) and peak aortic valve velocity (p = 0.01). Only the severity of AS was associated with syncope. The presence of hypertension was associated with angina (p = 0.04). Moreover, coronary angiography was performed in 59 patients before aortic valve replacement and revealed coronary stenosis (> 50% diameter stenosis) in 11/16 patients (69%) that had angina. The presence of coronary stenosis was significantly associated with angina (p = 0.02). The development of dyspnea, angina or syncope was influenced by different factors in AS.
  
  
  CONCLUSIONS
  Dyspnea and syncope were mainly associated with AS severity, and diastolic dysfunction also influenced dyspnea. In contrast, angina was mainly related to the presence of coronary stenosis rather than to AS severity. These factors should be considered when, selecting a therapeutic strategy for AS patients in the modern era.
authors.affiliation: Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nishizaki
authors.forename: Masao
authors.initials: M
authors.lastname: Daimon
authors.forename: Sakiko
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Suzuki
authors.forename: Takayuki
authors.initials: T
authors.lastname: Kawata
authors.forename: Katsumi
authors.initials: K
authors.lastname: Miyauchi
authors.forename: Shuo-Ju
authors.initials: SJ
authors.lastname: Chiang
authors.forename: Haruka
authors.initials: H
authors.lastname: Makinae
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Shinozaki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Daida
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D017023:Coronary Angiography / Q000379:methods; D004417:Dyspnea / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007564:Japan; D008297:Male; D008501:Medical Records, Problem-Oriented; D008875:Middle Aged; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D063189:Symptom Assessment / Q000379:methods / Q000706:statistics & numerical data; D013575:Syncope / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology