Clinical, haemodynamic, and coronary angiographic correlates of angina pectoris in patients with severe aortic valve disease

Abstract

Of 88 consecutive patients aged 20 to 77 yr with severe symptomatic aortic valve disease requiring surgery, 51 patients had angina pectoris; of these 51, 41 had predominant aortic stenosis, and 10 had severe aortic regurgitation. All patients with angina pectoris underwent coronary angiography; significant coronary arterial disease was encountered in 24% of those with aortic stenosis, and 20% of those with aortic regurgitation. By contrast, of 37 patients without angina pectoris, 19 underwent coronary arteriography; none showed significant coronary artery disease (P < 0.05). Among patients with angina pectoris, 17% of those with aortic stenosis experienced prolonged, rest or noctural pain, compared with 70% of those with aortic regurgitation (P < 0.005). At the time of onset of angina pectoris, there were features of heart failure in 34% of those with aortic stenosis, and in 90% of those with aortic regurgitation (P < 0.005). Nitroglycerin promptly relieved angina pectoris in 56% of patients with aortic stenosis, and in 50% of those with aortic regurgitation (P > 0.05). Neither the pattern of angina pectoris, nor the response to nitroglycerin was dependent upon the coexistence of significant coronary artery disease. In patients with aortic stenosis, there was no significant difference between those with angina pectoris and those without angina with regard to left ventricular end diastolic volume, end diastolic pressure, ejection fraction, peak systolic pressure, wall thickness, cardiac index, or the product of these factors. In patients with aortic regurgitation, cardiac index was significantly lower (P < 0.05), left ventricular end diastolic volume tended to be larger, and ejection fraction tended to be lower in patients with angina pectoris, as opposed to those without angina pectoris.