J Med Assoc Thai 1999; 82 (2):140

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Frequency of Angina Pectoris and Coronary Artery Disease in Severe Isolated Valvular Aortic Stenosis
Tansuphaswadikul S Mail, Silaruks S , Lehmongkol R , Chakorn T

Angina pectoris is a frequent symptom of severe valvular aortic stenosis (AS), even in the
presence of normal coronary arteries.
To determine the prevalence of angiographically significant coronary artery disease
(CAD) and its relation to angina pectoris and coronary risk factors in severe isolated valvular AS
All cases of symptomatic AS patients who underwent aortic valve replacement and preoperative
cardiac catheterization at the Central Chest Hospital between January I, 1986 and
December 31, 1996 were retrospectively analyzed. Excluded were those with multiple valvular
disease, aortic regurgitation of grade 2 or more, and prior coronary or valve surgery.
A total of ninety consecutive patients with severe AS (64 men and 26 women, mean age
58.94 years, range 38 to 71) were studied. Significant CAD (coronary diameter stenoses≥ 50%)
was found in 15 patients (16.7%). Typical angina was present in 66.7 per cent of them but it was
also found in 46.7 per cent of the non-CAD patients. This symptom had low positive predictive
value (22% ). Of the patients without angina (n=45) 11.1 per cent had significant CAD, The
negative predictive value of angina alone was thus 89 per cent. By univariate logistic regression,
the statistically significant variables to discriminate those with or without significant CAD were
age, history of hypertension, positive familial history of premature CAD, and cholesterol level.
However, only age and hypertension were statistically significant by multivariate logistic regression
Coronary arteriography can probably be omitted in severe valvular AS, especially those
without a history of hypertension and < 40 years of age in men and

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