Determinants of angina in aortic stenosis and the importance of coronary arteriography.

Abstract

Coronary arteriography was performed in 140 patients with aortic stenosis (peak systolic gradient > 50 mmHg). Coronary artery disease was found in 32 patients of whom 6% had no history of angina. Fifty-six patients presented with angina but had normal coronary arteriograms. Effort syncope was a presenting symptom in 34 patients of whom 9 had coronary artery disease. Patients with angina but normal coronary arteriograms had significantly greater peak left ventricular pressures, peak systolic gradients, left ventricular end-diastolic pressures and left ventricular masses than angina-free patients with normal coronary arteriograms. The ratio of diastolic pressure-time index (DPTI) to tension time index (TTI) and the aortic valve area were less in the patients with angina and normal coronary arteries than in angina-free patients. The concept of O2 demand exceeding supply in patients with severe aortic stenosis and normal coronary arteries was supported. Two surgical problems were related to operative mortality: a long bypass time and difficulty with coronary artery perfusion. High quality selective coronary arteriograms are essential in all patients undergoing cardiac catheterization for aortic stenosis if anatomical problems with coronary artery perfusion are to be avoided.