title: Aortic valve sclerosis as a marker of coronary artery atherosclerosis; a multicenter study of a large population with a low prevalence of coronary artery disease.
abstract: There are no studies analyzing the association between aortic valve sclerosis (AVS) and coronary artery disease (CAD) in a large and multicenter patient population with an overall low prevalence of CAD. We hypothesized that AVS could predict the presence and degree of CAD in patients with severe organic mitral regurgitation.
  
  
  METHODS
  We retrospectively analyzed consecutive patients with flail mitral leaflet who had coronary angiography for pre-surgical screening and not because suspect of CAD. End-points were considered: 1) any degree of CAD (stenosis>20%) and 2) obstructive CAD (stenosis>75% of at least one coronary artery). AVS was defined as focal areas of increased echogenicity and thickening of the leaflets. Traditional clinical risk factors were considered: age, male gender, hypertension (>140/90 mmHg or medical therapy), hypercholesterolemia (total cholesterol>200 mg/dl or statin), diabetes, family history of CAD and smoking habit.
  
  
  RESULTS
  675 patients (mean age: 64±12; 27% female) formed the study population. Among patients with AVS, 60% and 39% had any-CAD and ob-CAD respectively, on the opposite among patients without AVS 12% and 7% had any-CAD and ob-cad. After adjustment for clinical risk factors, AVS was associated with a 22.7 fold increased risk of any degree of CAD (95% CI 8.1 63.6 p<0.0001) and with a 21.8 fold increased risk of obstructive-CAD (95% CI 6.6 71.9; p<0.0001).
  
  
  CONCLUSIONS
  In a large and multicenter sample of patient with flail mitral leaflet, AVS was strongly associated with the presence and degree of CAD independently of clinical risk factors.
authors: Department of Medicine, Section of Cardiology, University of Verona, Italy. Electronic address: andrea.rossi@ospedaleuniverona.it.
authors: Andrea
authors: A
authors: Rossi
authors: Department of Cardiology, University of Parma, Italy.
authors: Nicola
authors: N
authors: Gaibazzi
authors: Department of Medicine, Section of Cardiology, University of Verona, Italy.
authors: Raje
authors: R
authors: Dandale
authors: San Raffaele Hospital, Department of Cardiology, Milan, Italy.
authors: Eustachio
authors: E
authors: Agricola
authors: Department of Cardiology, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Antonella
authors: A
authors: Moreo
authors: Civil Hospital of Brescia, Department of Cardiology, Brescia, Italy.
authors: Nicola
authors: N
authors: Berlinghieri
authors: Department of Cardiology, University of Parma, Italy.
authors: Daniele
authors: D
authors: Sartorio
authors: San Raffaele Hospital, Department of Cardiology, Milan, Italy.
authors: Marco
authors: M
authors: Loffi
authors: Department of Cardiology, Niguarda Ca' Granda Hospital, Milan, Italy.
authors: Benedetta
authors: B
authors: De Chiara
authors: UOC Cardiologia Ospedale dell'Angelo Mestre-Venezia, Italy.
authors: Fausto
authors: F
authors: Rigo
authors: Department of Medicine, Section of Cardiology, University of Verona, Italy.
authors: Corrado
authors: C
authors: Vassanelli
authors: Civil Hospital of Brescia, Department of Cardiology, Brescia, Italy.
authors: Pompilio
authors: P
authors: Faggiano
mesh_terms: D001021:Aortic Valve; D000082882:Bicuspid Aortic Valve Disease; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D004452:Echocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D006349:Heart Valve Diseases / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012598:Sclerosis; D011795:Surveys and Questionnaires
keywords: Aortic valve sclerosis; Coronary artery disease; Organic mitral regurgitation