Protective Effect of Aortic Stenosis on the Coronary Arteries. Hypothetic Considerations to an Old Enigma

Overview

Journal Arq Bras Cardiol

Specialty Cardiology & Vascular Diseases

Date 2016 May 5

PMID 27142794

Citations 1

Authors

Paulo Roberto Barbosa Evora

Livia Arcencio

Alfredo Jose Rodrigues

Andre Schmidt

Affiliations

Soon will be listed here.

Abstract

A literature overview of angiographic studies has shown that the prevalence of significant coronary disease in patients with aortic stenosis (AS) varies from 20 to 60%. Early necropsy studies suggested that patients with AS had a lower than expected incidence of coronary artery disease (CAD), originating the concept of a protective effect of AS on the coronary arteries. The myth of AS protection against CAD would be better explained as endothelium-myocardial interaction (crosstalk) protection triggered by left ventricular overload. Therefore, the cGMP/NO pathway induced by the AS overload pressure would explain the low incidence of CAD, which is compatible with the amazing natural long-term evolution of this cardiac valve disease.

Citing Articles

Speculative Considerations about Some Cardiology Enigmas.

Evora P, Schmidt A, Arcencio L, Marin-Neto J Curr Cardiol Rev. 2017; 13(3):217-222.

PMID: 28317490 PMC: 5633716. DOI: 10.2174/1573403X13666170317121721.

References

Nakib A, Lillehei C, Edwards J . The degree of coronary atherosclerosis in aortic valvular disease. Arch Pathol. 1965; 80(5):517-20. View

MORRISON G, Thomas R, Grimmer S, Silverton P, Smith D . Incidence of coronary artery disease in patients with valvular heart disease. Br Heart J. 1980; 44(6):630-7. PMC: 482459. DOI: 10.1136/hrt.44.6.630. View

Exadactylos N, Sugrue D, Oakley C . Prevalence of coronary artery disease in patients with isolated aortic valve stenosis. Br Heart J. 1984; 51(2):121-4. PMC: 481471. DOI: 10.1136/hrt.51.2.121. View

Abdulali S, Baliga B, Clayden A, Smith D . Coronary artery luminal diameter in aortic stenosis. Am J Cardiol. 1985; 55(4):450-3. DOI: 10.1016/0002-9149(85)90392-3. View

Kimball B, LiPreti V, Bui S, Wigle E . Comparison of proximal left anterior descending and circumflex coronary artery dimensions in aortic valve stenosis and hypertrophic cardiomyopathy. Am J Cardiol. 1990; 65(11):767-71. DOI: 10.1016/0002-9149(90)91385-j. View

Villari B, Hess O, Meier C, Pucillo A, Gaglione A, Turina M . Regression of coronary artery dimensions after successful aortic valve replacement. Circulation. 1992; 85(3):972-8. DOI: 10.1161/01.cir.85.3.972. View

Salerno T . Coronary revascularization in the setting of surgical aortic valve replacement: do we need extra icing on the cake?. J Thorac Cardiovasc Surg. 2015; 149(2):460-1. DOI: 10.1016/j.jtcvs.2014.11.049. View

Kaufmann P, Vassalli G, Jenni R, Hess O . Coronary artery dimensions in primary and secondary left ventricular hypertrophy. J Am Coll Cardiol. 1996; 28(3):745-50. DOI: 10.1016/0735-1097(96)00194-5. View

Brutsaert D, Fransen P, Andries L, De Keulenaer G, Sys S . Cardiac endothelium and myocardial function. Cardiovasc Res. 1998; 38(2):281-90. DOI: 10.1016/s0008-6363(98)00044-3. View

10.

HORAN Jr M, BARNES A . Calcareous aortic stenosis and coronary artery disease. Am J Med Sci. 1948; 215(4):451-5. DOI: 10.1097/00000441-194804000-00015. View

11.

Nishimura R, Otto C, Bonow R, Carabello B, Erwin 3rd J, OGara P . 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg. 2014; 148(1):e1-e132. DOI: 10.1016/j.jtcvs.2014.05.014. View

12.

Cho E, Park S, Chang S, Jeong D, Lee S, Park S . Incidence of coronary artery disease before valvular surgery in isolated severe aortic stenosis. Chin Med J (Engl). 2014; 127(22):3963-9. View

13.

Thalji N, Suri R, Daly R, Greason K, Dearani J, Stulak J . The prognostic impact of concomitant coronary artery bypass grafting during aortic valve surgery: implications for revascularization in the transcatheter era. J Thorac Cardiovasc Surg. 2014; 149(2):451-60. DOI: 10.1016/j.jtcvs.2014.08.073. View

14.

Paulus W, Vantrimpont P, Shah A . Paracrine coronary endothelial control of left ventricular function in humans. Circulation. 1995; 92(8):2119-26. DOI: 10.1161/01.cir.92.8.2119. View