Acute coronary syndromes and atherosclerotic plaque burden distribution in coronary arteries among patients with valvular heart disease (BIA-WAD registry)

Łukasz Kuźma, Hanna Bachórzewska-Gajewska, Marcin Kożuch, Krzysztof Struniawski, Szymon Pogorzelski, Tomasz Hirnle, Sławomir Dobrzycki, Łukasz Kuźma, Hanna Bachórzewska-Gajewska, Marcin Kożuch, Krzysztof Struniawski, Szymon Pogorzelski, Tomasz Hirnle, Sławomir Dobrzycki

Abstract

Introduction: Valvular heart diseases (VHD) are a significant problem in the Polish population. Coexistence of coronary artery disease (CAD) in patients with VHD increases the risk of death and affects the further therapeutic strategy.

Aim: Analysis of atherosclerotic plaque burden distribution in coronary arteries and long-term prognosis among patients with VHD.

Material and methods: Inclusion criteria were met by 1025 patients with moderate and severe VHD. Mean observation time was 2528 ±1454 days.

Results: Severe aortic valve stenosis (AVS) occurred in 28.2%, severe mitral valve insufficiency (MVI) in 20%. CAD with severe angiographic stenoses was noted in 42.3% (n = 434). Among patients with severe MVI, CAD was noted in 47.1% of cases, and prior acute coronary syndromes (ACS) in 27.1% of patients (n = 58). In severe AVS patients, significant angiographic atherosclerotic changes were observed in 29.6% (n = 86), and prior ACS in 7.6% (n = 22) of patients. During the observation 52.7% of patients died, including 62.9% of patients with severe MVI and 51.6% of those with severe AVS. Age (OR = 1.038; 95% CI: 1.005-1.072; p = 0.022) and coexisting aortic valve insufficiency (AVI) (OR = 2.39, 95% CI: 5.370-11.065, p = 0.035) increased the mortality rate.

Conclusions: Severe AVS is starting to be the most prevalent VHD. CAD is one of the most significant factors deteriorating prognosis of patients with VHD. AVI and age were significant risk factors for mortality. The worst prognosis was observed in severe MVI, which may result from more frequent occurrence of CAD in this group. A lesser burden of CAD and ACS in the group of patients with severe AVS did not affect survival.

Keywords: aortic stenosis; coronary artery disease; mitral insufficiency; myocardial infarction.

Conflict of interest statement

The authors declare no conflict of interest.

Copyright: © 2019 Termedia Sp. z o. o.

Figures

Figure 1
Figure 1
Valvular heart diseases in the study population
Figure 2
Figure 2
Comparison of dead and alive patients (only significant differences presented, p < 0.05) AVI – aortic valve insufficiency, CAD – coronary artery disease, Cx – circumflex artery, Diag – diagonal artery, LAD – left anterior descending, LM – left main artery, NSTEMI – non-ST elevation myocardial infarction, MVI – mitral valve insufficiency, STEMI – ST elevation myocardial infarction, RCA – right coronary artery.

References

    1. Strzelecki Z, Szymborski J. Zachorowalność i umieralność na choroby układu krążenia a sytuacja demograficzna Polski. 2015. pp. 1–28. Available at: .
    1. Ray S. Changing epidemiology and natural history of valvular heart disease. Clin Med. 2010;10:168–71.
    1. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on valvular heart disease. Eur Heart J. 2003;24:1231–43.
    1. Hryniewiecki T, Stępińska J. WadPol – POLKARD. Ogólnopolski Rejestr Nabytych Wad Zastawkowych. Kardiol Pol. 2009:67. W169 (abstr.)
    1. McMurray JJ, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Failure. 2012;14:803–69.
    1. Departament Badań Demograficznych GUS . Prognoza ludności Polski na lata 2008-2035. Główny Urząd Statystyczny; 2018. pp. 147–190. Available at: .
    1. Toggweiler S, Zuber M, Surder D, et al. Two-year outcomes after percutaneous mitral valve repair with the MitraClip system: durability of the procedure and predictors of outcome. Open Hear. 2014;1:e000056.
    1. Moat NE, Ludman P, De Belder M, et al. Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: The U.K. TAVI (United Kingdom transcatheter aortic valve implantation) registry. J Am Coll Cardiol. 2011;58:2130–8.
    1. Mohr FW, Holzhey D, Möllmann H, et al. The German Aortic Valve Registry: 1-year results from 13 680 patients with aortic valve disease. Eur J Cardiothorac Surg. 2014;46:1–9.
    1. Departament Badań Demograficznych GUS . Ludność według, płci, województwa i podregionów 2016. Available at: . Assessed February 28, 2019.
    1. Ghosh P. Changing trends in valve surgery in Europe: 1991-2000. J Heart Valve Dis. 2004;13:1–10.
    1. Giannoglou GD, Antoniadis AP, Chatzizisis YS, et al. Difference in the topography of atherosclerosis in the left versus right coronary artery in patients referred for coronary angiography. BMC Cardiovasc Disord. 2010;10:26.
    1. Wasilewski J, Niedziela J, Osadnik T, et al. Predominant location of coronary artery atherosclerosis in the left anterior descending artery. The impact of septal perforators and the myocardial bridging effect. Kardiochir Torakochir Pol. 2015;12:379–85.
    1. Roques F, Nashef SA, Michel P, et al. Risk factors and outcome in European cardiac surgery: analysis of the EuroSCORE multinational database of 19030 patients. Eur J Cardiothorac Surg. 1999;15:813–6.
    1. Edwards FH, Peterson ED, Coombs LP, et al. Prediction of operative mortality after valve replacement surgery. J Am Coll Cardiol. 2001;37:885–92.
    1. Hamamoto M, Bando K, Kobayashi J, et al. Durability and outcome of aortic valve replacement with mitral valve repair versus double valve replacement. Ann Thorac Surg. 2003;75:24–8.
    1. Mihaljevic T, Lam BK, Rajeswaran J, et al. Impact of mitral valve annuloplasty combined with revascularization in patients with functional ischemic mitral regurgitation. J Am Coll Cardiol. 2007;49:2191–201.
    1. Niedziela J, Osadnik T, Roleder M, et al. Atherosclerotic plaque burden distribution in the coronary arteries. The myocardial bridging effect. Choroby Serca Naczyń. 2015;12:19–24.
    1. Lee S, Choi EK, Chang HJ, et al. Subclinical coronary artery disease as detected by coronary computed tomography angiography in an asymptomatic population. Korean Circ J. 2010;40:434–41.
    1. Enrico B, Suranyi P, Thilo C, et al. Coronary artery plaque formation at coronary CT angiography: morphological analysis and relationship to hemodynamics. Eur Radiol. 2009;19:837–44.
    1. Mihaljevic T, Lam BK, Rajeswaran J, et al. Impact of mitral valve annuloplasty combined with revascularization in patients with functional ischemic mitral regurgitation. J Am Coll Cardiol. 2007;49:2191–201.
    1. Maruszewski B TZ. Raport Krajowego Rejestru Operacji Kardiochirurgicznych KROK-POLKARD. 2016. Available at: .
    1. Unger P, Dedobeleer, Cosyns B, et al. Mitral regurgitation in patient with aortic stenosis undergoing valve replacement. Heart. 2010;96:9–14.
    1. The Sixth National Adult Cardiac Database Report 2008. 6th edn. Society for Cardiothoracic Surgery in Great Britain and Ireland; 2009.
    1. Oxenham H, Bloomfield P, Wheatley DJ, et al. Twenty year comparison of a Björk-Shiley mechanical heart valve with porcine bioprostheses. Heart. 2003;89:715–21.
    1. Enriquez-Sarano M, Akins CW, Vahanian A. Mitral regurgitation. Lancet. 2009;373:1382–94.
    1. Peterseim DS, Cen YY, Cheruvu S, et al. Long-term outcome after biologic versus mechanical aortic valve replacement in 841 patients. J Thorac Cardiovasc Surg. 1999;117:890–7.
    1. Ruel M, Kulik A, Lam BK, et al. Long-term outcomes of valve replacement with modern prostheses in young adults. Eur J Cardiothorac Surg. 2005;27:425–33.

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel