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VALVE DISEASE
Interface between valve disease and ischaemic heart disease
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  1. Bernard Iung
  1. Cardiology Department, Bichat Hospital, Paris, France
  1. Dr Bernard Iung, Cardiology Department, Bichat Hospital, 46, rue Henri Huchard, 75018 Paris, France email: bernard.iung{at}bch.ap-hop-paris.fr

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The association of coronary artery disease with heart valve disease is frequently encountered and it can be expected that this association will become more common because of the evolution in the epidemiology of valvar diseases. Degenerative lesions are now the most frequent cause of valve disease in western countries and they frequently occur in old patients, who are also at higher risk for atherosclerotic disease. The association of calcified aortic stenosis and coronary heart disease is the main problem, because it is the most frequently encountered association and because it raises specific questions, particularly in regard to the detection and management of both pathologies. Despite many reports in the literature, recently published guidelines point out the fact that concern remains regarding the optimal strategies for diagnosis and treatment of coronary artery disease in patients with valve disease.1

Calcific aortic stenosis associated with coronary artery disease

Frequency of coronary artery disease in patients with calcified aortic stenosis

The frequency of coronary artery disease in patients with calcified aortic stenosis can be correctly assessed only in studies comprising systematic coronary angiography, regardless of the symptoms. The frequency of associated coronary disease varies according to the characteristics of the population involved, in particular age and, to a lesser degree, the geographic origin. Series of patients with calcific aortic stenosis whose mean age is between 60 and 70 years reported 30–50% of associated significant coronary artery disease (at least one stenosis > 50% or 70% of vessel diameter). Coronary artery disease has been reported in more than 50% of patients aged ⩾ 70 years2 and, of patients aged ⩾ 80 years, in 65% in series from the USA3 and 41% in a British series.4

Series published in the 1960s and '70s led certain authors to suggest that aortic stenosis could have a protective role against coronary atherosclerosis. This was in fact probably only the consequence of a selection bias in series in …

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Supplementary materials

  • Additional references for "Interface between valve disease and ischaemic heart disease" by Bernard Iung.Heart 2000;84:347-352.
     

    Association of coronary artery and heart valve diseases : frequency and pathogenesis

    1. Ramsdale DR, Bennett DH, Bray CL, et al. Angina, coronary risk factors and coronary artery disease in patients with valvular disease. A prospective study. Eur Heart J 1984;5:716-26.
    2. Timmermans Ph, Willems JL, Piessens J, et al. Angina pectoris and coronary artery disease in severe aortic regurgitation. Am J Cardiol 1988;61:826-9.
    3. Mattina CJ, Green SJ, Tortolani AJ, et al. Frequency of angiographically significant coronary arterial narrowing in mitral stenosis. Am J Cardiol 1986;57:802-5.
    4. Gupta KG, Loya YS, Bhagwat AR, et al. Prevalence of significant coronary heart disease in valvular heart disease in Indian patients. Indian Heart J 1990;42:357-9.
    5. Aronow WS, Kronzon I, Schoenfeld MR. Prevalence of extracranial carotid arterial disease and of valvular aortic stenosis and their association in the elderly. Am J Cardiol 1995;75:304-5.
    6. Omran H, Fehske W, Rabahieh R, et al. Relation between symptoms and profiles of coronary artery blood flow velocities in patients with aortic valve stenosis: a study using transoesophageal Doppler echocardiography. Heart 1996;75:377-83.
    7. Enriquez-Sarano M, Klodas E, Garratt KN, et al. Secular trends in coronary atherosclerosis : analysis in patients with valvular regurgitation. N Engl J Med 1996;335:316-22.
    8. Otto CM, Burwash IG, Legget ME, et al. Prospective study of asymptomatic valvular aortic stenosis. Clinical, echocardiographic, and exercise predictors of outcome. Circulation 1997;95:2262-70.
    9. Aronow WS, Ahn C, Shirani J, et al. Comparison of new coronary events in older persons with mild, moderate, and severe valvular aortic stenosis with those without aortic stenosis. Am J Cardiol 1998;81:647-9.


    Detection of coronary artery disease associated to heart valve disease

    1. Ramsdale DR, Faragher EB, Bennett DH, et al. Preoperative prediction of significant coronary artery disease in patients with valvular heart disease. BMJ 1982;284:223-6.
    2. Huikuri HV, Korhonen UR, Ikaheimo MJ, et al. Detection of coronary artery disease by thallium imaging using a combined intravenous dipyridamole and isometric handgrip test in patients with aortic valve stenosis. Am J Cardiol 1987;59:336-40.
    3. Atwood JE, Kawanishi S, Myers J, et al. Exercise testing in patients with aortic stenosis. Chest 1988;93:1083-7.
    4. Friedman HZ, Goldberg SF, Hauser AM, et al. Death with dipyridamole thallium imaging. Ann Intern Med 1988;109:990-1.
    5. Huikuri HV, Airaksinen KEJ, Ikaheimo MJ, et al. Detection of coronary artery disease by dipyridamole thallium tomography in mitral valve stenosis. Am J Cardiol 1989;63:124-6.
    6. Georgeson S, Meyer KB, Pauker SG. Decision analysis in clinical cardiology: when is coronary angiography required in aortic stenosis? J Am Coll Cardiol 1990;155:751-62.
    7. Kupari M, Virtanen KS, Turto H, et al. Exclusion of coronary artery disease by exercise thallium 201 tomography in patients with aortic valve stenosis. Am J Cardiol 1992;70:635-40.
    8. Kettunen R, Huikuri HV, Heikkila J, et al. Preoperative diagnosis of coronary artery disease in patients with valvular heart disease using technetium-99m isonitrile tomographic imaging together with high-dose dipyridamole and handgrip exercise. Am J Cardiol 1992;69:1442-5.
    9. Samuels B, Kiat H, Friedman JD, et al. Adenosine pharmacologic stress myocardial perfusion tomographic imaging in patients with significant aortic stenosis. Diagnostic efficacy and comparison of clinical, hemodynamic and electrocardiographic variables with 100 age-matched control subjects. J Am Coll Cardiol 1995;25:99-106.
    10. Aschenbach S, Moshage W, Ropers D, et al. Value of electron-beam computed tomography for the noninvasive detection of high-grade coronary artery stenoses and occlusions. N Engl J Med 1998;339:1964-71.
    11. Triboulloy C, Peltier M, Rey JL, et al. Use of transoesophageal echocardiography to predict significant coronary artery disease in aortic stenosis. Chest 1998;113:671-5.
    12. Maffei S, Baroni M, Terrazzi M, et al. Preoperative assessment of coronary artery disease in aortic stenosis: a dipyridamole echocardiographic study. Ann Thorac Surg 1998;65:397-402.


    Aortic valve replacement and coronary artery surgery

    1. Jones M, Schofield PM, Brooks NH, et al. Aortic valve replacement with combined myocardial revascularisation. Br Heart J 1989;62:9-15.
    2. Magovern JA, Pennock JL, Campbell DB, et al. Aortic valve replacement and combined aortic valve replacement and coronary artery bypass grafting: Predicting high risk groups. J Am Coll Cardiol 1987;9:38-43.
    3. Otto CM, Pearlman AS, Gardner CL. Hemodynamic progression of aortic stenosis in adults assessed by Doppler echocardiography. J Am Coll Cardiol 1989;13:545-50.
    4. Lytle BW. Impact of coronary artery disease on valvular heart surgery. Cardiol Clin 1991;9:301-14.
    5. Aranki SF, Rizzo RJ, Couper GS, et al. Aortic valve replacement in the elderly : effect of gender and coronary artery disease on operative mortality. Circulation 1993;88:II17-23.
    6. Turpie AGG, Gent M, Laupacis A, et al. A comparison of aspirin with placebo in patients treated with warfarin after heart valve replacement. N Engl J Med 1993;329:524-9.
    7. Gohlke-Bärwolf C, Acar J, Oakley C, et al. Guidelines for prevention of thromboembolic events in valvular heart disease. Study group of the Working Group on Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 1995;16:1320-30.
    8. Angell WH, Pupello DF, Bessone LN, et al. Influence of coronary artery disease on structural deterioration of porcine bioprostheses. Ann Thorac Surg 1995;60:S276-81.
    9. Adkins MS, Amalfitano D, Harnum NA, et al. Efficacy of combined coronary revascularization and valve procedures in octogenarians. Chest 1995;108:927-31.
    10. Fiore AC, Swartz MT, Naunheim KS, et al. Management of asymptomatic mild aortic stenosis during coronary artery operations. Ann Thorac Surg 1996;61:1693-8.
    11. The Post Coronary Artery Bypass Graft Trial Investigators. The effect of aggressive lowering of low-density lipoprotein cholesterol levels and low-dose anticoagulation on obstructive changes in saphenous-vein coronary-artery bypass grafts. N Engl J Med 1997;336:153-62.


    Mitral valve surgery and coronary artery surgery for non-ischaemic mitral valve diseases

    1. Czer LSC, Gray RJ, DeRobertis MA, et al. Mitral valve replacement: impact of coronary artery disease and determinants of prognosis after revascularization. Circulation 1984;70(suppl I):I198-207.
    2. Cohn LH, Couper GS, Kinchla NM, et al. Decreased operative risk of surgical treatment of mitral regurgitation with or without coronary artery disease. J Am Coll Cardiol 1990;16:1575-8.
    3. Enriquez Sarano M, Tajik AJ, Schaff HV, et al. Echocardiographic prediction of left ventricular function after correction of mitral regurgitation: results and clinical implications. J Am Coll Cardiol 1994;24:1536-43.
    4. Hughes GC, Donovan CL, Lowe JE, et al. Combined TMR and mitral valve replacement via left thoracotomy. Ann Thorac Surg 1998;65:1141-3.


    Ischaemic mitral regurgitation: mechanisms and treatment

    1. Kono T, Sabbah HN, Stein PD, et al. Left ventricular shape as a determinant of functional mitral regurgitation in patients with severe heart failure secondary to either coronary artery disease or idiopathic dilated cardiomyopathy. Am J Cardiol 1991;68:355-9.
    2. Fehrenbacher G, Schmidt DH, Bommer WJ. Evaluation of transient mitral regurgitation in coronary artery disease. Am J Cardiol 1991;68:868-73.
    3. Kaul S, Spotnitz WD, Glasheen WP, et al. Mechanism of ischemic mitral regurgitation. An experimental evaluation. Circulation 1991;84:2167-80.
    4. Hickey MStJ, Smith LR, Muhlbaier LH, et al. Current prognosis of ischemic mitral regurgitation. Implications for future management. Circulation 1988,78(suppl I): I51-9.
    5. Kay GL, Kay JH, Zubiate P, et al. Mitral valve repair for mitral regurgitation secondary to coronary artery disease. Circulation 1986;74(suppl II):II88-98.
    6. Rankin JS, Feneley MP, Hickey MStJ, et al. A clinical comparison of mitral valve repair versus valve replacement in ischaemic mitral regurgitation. J Thorac Cardiovasc Surg 1988;95:165-77.
    7. Rankin JS, Hickey MStJ, Smith LR, et al. Ischemic mitral regurgitation. Circulation 1989;79(suppl I):I116-21.
    8. Sheikh KH, Bengston JR, Rankin JS, et al. Intraoperative transoesophageal doppler color flow imaging used to guide patient selection and operative treatment of ischemic mitral regurgitation. Circulation 1991;84:594-604.
    9. He GW, Hughes CF, McCaughan B, et al. Mitral valve replacement combined with coronary artery operation: determinants of early and late results. Ann Thorac Surg 1991;51:916-23.
    10. Czer LSC, Maurer G, Trento A, et al. Comparative efficacy of ring and suture annuloplasty for ischemic mitral regurgitation. Circulation 1992;86(suppl II):II46-52.
    11. Le Feuvre C, Metzger JP, Lachurie ML, et al. Treatment of severe mitral regurgitation caused by ischemic papillary muscle dysfunction: indications for coronary angioplasty. Am Heart J 1992;123:860-5.
    12. Komeda M, Glasson JR, Bolger AF, et al. Geometric determinants of ischemic mitral regurgitation. Circulation 1997;96(suppl II):II128-33.

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