Significance of Coronary Artery Disease and Left Ventricular Afterload in Unoperated Asymptomatic Aortic Stenosis

Kentaro Shibayama; Masao Daimon; Hiroyuki Watanabe; Takayuki Kawata; Sakiko Miyazaki; Ryoko Morimoto-Ichikawa; Masaki Maruyama; Shuo-Ju Chiang; Katsumi Miyauchi; Hiroyuki Daida

doi:10.1253/circj.CJ-15-0876

Valvular Heart Disease

Significance of Coronary Artery Disease and Left Ventricular Afterload in Unoperated Asymptomatic Aortic Stenosis

Kentaro Shibayama, Masao Daimon, Hiroyuki Watanabe, Takayuki Kawata, Sakiko Miyazaki, Ryoko Morimoto-Ichikawa, Masaki Maruyama, Shuo-Ju Chiang, Katsumi Miyauchi, Hiroyuki Daida

Author information

Kentaro Shibayama
Department of Cardiology, Juntendo University School of Medicine
Heart Center, Tokyo Bay Urayasu/Ichikawa Medical Center
Masao Daimon
Department of Cardiology, Juntendo University School of Medicine
Hiroyuki Watanabe
Heart Center, Tokyo Bay Urayasu/Ichikawa Medical Center
Takayuki Kawata
Department of Cardiology, Juntendo University School of Medicine
Sakiko Miyazaki
Department of Cardiology, Juntendo University School of Medicine
Ryoko Morimoto-Ichikawa
Department of Cardiology, Juntendo University School of Medicine
Masaki Maruyama
Department of Cardiology, Juntendo University School of Medicine
Shuo-Ju Chiang
Department of Cardiology, Juntendo University School of Medicine
Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University
Katsumi Miyauchi
Department of Cardiology, Juntendo University School of Medicine
Hiroyuki Daida
Department of Cardiology, Juntendo University School of Medicine

Keywords: Aortic stenosis, Coronary artery disease, Echocardiography, Valve disease surgery, Valvular heart disease

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2016 Volume 80 Issue 2 Pages 519-525

DOI https://doi.org/10.1253/circj.CJ-15-0876

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Abstract

Background:Because the covariates of cardiovascular events in unoperated patients with asymptomatic aortic stenosis (AS) have not been adequately evaluated, we aimed to identify them.Methods and Results:A total of 230 patients with asymptomatic severe AS were retrospectively enrolled. The patients were divided into 2 groups based on aortic valve replacement (AVR) after enrollment: a non-AVR group (n=112), and an AVR group (n=118). The primary clinical endpoint was cardiovascular events, which were defined as cardiovascular death or hospitalization. Coronary artery disease [hazard ratio (HR): 3.62, 95% confidence interval (CI): 1.585–8.245, P<0.01] and high valvulo-arterial impedance (HR: 3.08, 95% CI: 1.261–7.532, P<0.05) were identified as independent covariates of cardiovascular events in the non-AVR group. The relative risk of cardiovascular events rose with an increase in the number of risk factors (P<0.0001).Conclusions:In unoperated patients with asymptomatic AS, the presence of coronary artery disease and increased global left ventricular afterload may be associated with a poor prognosis. (Circ J 2016; 80: 519–525)

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