Korean Circ J.  2009 Jul;39(7):275-279. 10.4070/kcj.2009.39.7.275.

Aortic Valve Sclerosis on Echocardiography is a Good Predictor of Coronary Artery Disease in Patients With an Inconclusive Treadmill Exercise Test

• Kim DB
• Jung HO
• Jeon DS
• Park CS
• Jang SW
• Park HJ
• Kim PJ
• Baek SH
• Seung KB
• Rho TH
• Kim JH
• Choi KB

• KMID: 2145563
• DOI: http://doi.org/10.4070/kcj.2009.39.7.275

Abstract

BACKGROUND AND OBJECTIVES
The treadmill exercise test (TMT) is used as a first-line test for diagnosing coronary artery disease (CAD). However, the findings of a TMT can be inconclusive, such as incomplete or equivocal results. Aortic valve sclerosis (AVS) is known to be a good predictor of CAD. We determined the usefulness of assessing AVS on 2-dimensional (2D) echocardiography for making the diagnosis of CAD in patients with inconclusive results on a TMT. SUBJECTS AND METHODS: This prospective study involved 165 consecutive patients who underwent a TMT that resulted in inconclusive findings, 2D echocardiography to detect AVS, and coronary angiography to detect CAD. Following echocardiography, AVS was classified as none, mild, or severe. CAD was defined as > or =70% narrowing of the luminal diameter on coronary angiography. RESULTS: CAD was more common in patients with AVS than in patients without AVS (75% vs. 47%, respectively, p<0.01). Multiple logistic regression analysis showed that AVS was the only independent predictor of CAD {odds ratio=8.576; 95% confidence interval (CI), 3.739-19.672}. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of the presence of AVS for predicting CAD in a patient with an inconclusive TMT were 62%, 67%, 64%, 75%, and 53%, respectively. During a 1-year clinical follow-up, patients with and without AVS were similar in terms of event-free survival rates. CONCLUSION: If the results of TMT for patients with chest pain on exertion are inconclusive, the presence of AVS on echocardiography is a good predictor of CAD.

Keyword

Echocardiography; Treadmill test; Aortic valve; Sclerosis; Coronary artery disease

MeSH Terms

Aortic Valve
Chest Pain
Coronary Angiography
Coronary Artery Disease
Coronary Vessels
Disease-Free Survival
Echocardiography
Exercise Test
Follow-Up Studies
Humans
Logistic Models
Phenobarbital
Prospective Studies
Sclerosis
Sensitivity and Specificity
Phenobarbital

Figure

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  Fig. 1 Prevalence of coronary artery disease according to aortic valve sclerosis. CAD: coronary artery disease, AVS: aortic valve sclerosis.

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  Fig. 2 Prevalence of coronary artery disease according to gender and age. A: prevalence of coronary artery disease in males and females with and without aortic valve sclerosis. B: prevalence of coronary artery disease in patients aged ≤60 years and >60 years with and without aortic valve sclerosis. AVS: aortic valve sclerosis, CAD: coronary artery disease.

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  Fig. 3 The diagnostic value of aortic valve sclerosis for coronary artery disease. A: in inconclusive and positive treadmill exercise test patients (n=317). B: in inconclusive treadmill exercise test patients (n=165). PPV: positive predictive value, NPV: negative predictive value, AVS: aortic valve sclerosis.

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  Fig. 4 Kaplan-Meier curves for event-free survival in patients with and without aortic valve sclerosis. Event-free survival was similar in both groups. AVS: aortic valve sclerosis.

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