Cacodcar Sanjiva, Candeias Rui, Pereira Salomé, Gomes Veloso
Serviço de Cardiologia, Hospital Distrital de Faro, Faro, Portugal.
Rev Port Cardiol. 2005 Apr;24(4):559-65.
Degenerative changes of the mitral annulus are associated with atherosclerotic disease. It has recently been suggested that degenerative changes in the aortic valve may also be associated with atherosclerosis. The intima-media thickness of the carotid arteries has been used as one of the best and earliest markers of atherosclerosis. The aim of this study was to evaluate whether the additional presence of degenerative changes in the aortic valve in coronary patients with mitral annular degenerative disease reflects different degrees of intima-media thickness as assessed by carotid ultrasonography.
The study group included 55 patients admitted for myocardial infarction who presented with degenerative changes of the mitral annulus assessed by echocardiography. Exclusion criteria were moderate or severe valvular heart disease and chronic renal failure. All patients underwent echocardiography, cardiac Doppler and carotid ultrasonography. Based on the echocardiographic findings, two sub-groups were formed: 1--with degenerative changes of the aortic valve; and 2--without degenerative changes of the aortic valve. Carotid ultrasonography was performed with a 7.5-10 MHz linear transducer and the following parameters were evaluated: 1--bilateral measurement of intima-media thickness in the common carotid artery; 2-- incidence of atheromatous plaques in the carotid arteries, and 3--incidence of >50% lesion in the internal carotid arteries assessed by pulsed Doppler (Vmax >125 cm/s).
Thirty-three patients (aged 71.6 +/- 7.1 years), 21 men and 12 women, did not present degenerative changes in the aortic valve. The other group consisted of 22 individuals (aged 72.9 +/- 6.8 years), 14 men and 8 women, who did have such changes. Differences in age and gender distribution between the two groups were not significant. Patients with degenerative aortic valve disease had greater intima-media thickness than the control group (1.6 +/- 0.3 mm versus 1.3 +/- 0.4 mm, p < 0.001). Fifteen (68%) patients with aortic degenerative disease had plaques in the carotid arteries compared to 11 (33%) patients in the control group (p < 0.05). No significant differences were found between the two groups regarding the incidence of >50% atherosclerotic lesion in the internal carotid artery (22% versus 12%; NS).
Patients with degenerative changes in the aortic valve presented significantly greater intima-media thickness and a higher incidence of atherosclerotic plaques than the control group, suggesting that their presence may constitute an additional important marker of severity of atherosclerotic disease.
二尖瓣环的退行性改变与动脉粥样硬化疾病相关。最近有人提出，主动脉瓣的退行性改变也可能与动脉粥样硬化有关。颈动脉内膜中层厚度已被用作动脉粥样硬化最好且最早的标志物之一。本研究的目的是评估在患有二尖瓣环退行性疾病的冠心病患者中，主动脉瓣额外存在退行性改变是否反映了通过颈动脉超声检查评估的不同程度的内膜中层厚度。
研究组包括55例因心肌梗死入院且经超声心动图评估存在二尖瓣环退行性改变的患者。排除标准为中度或重度瓣膜性心脏病及慢性肾衰竭。所有患者均接受了超声心动图、心脏多普勒检查和颈动脉超声检查。根据超声心动图检查结果，形成了两个亚组：1组——有主动脉瓣退行性改变；2组——无主动脉瓣退行性改变。使用7.5 - 10MHz线性换能器进行颈动脉超声检查，并评估以下参数：1——双侧颈总动脉内膜中层厚度测量；2——颈动脉粥样斑块的发生率；3——通过脉冲多普勒评估的颈内动脉>50%病变的发生率（Vmax>125cm/s）。
33例患者（年龄71.6±7.1岁），男性21例，女性12例，主动脉瓣无退行性改变。另一组由22例个体（年龄72.9±6.8岁）组成，男性14例，女性8例，有主动脉瓣退行性改变。两组之间年龄和性别分布差异无统计学意义。患有主动脉瓣退行性疾病的患者内膜中层厚度大于对照组（1.6±0.3mm对1.3±0.4mm，p<0.001）。15例（68%）患有主动脉退行性疾病的患者颈动脉有斑块，而对照组为11例（33%）（p<0.05）。两组之间颈内动脉>%50动脉粥样硬化病变的发生率无显著差异（22%对12%；无统计学意义）。
与对照组相比，有主动脉瓣退行性改变的患者内膜中层厚度明显更大，动脉粥样硬化斑块发生率更高，这表明主动脉瓣退行性改变的存在可能构成动脉粥样硬化疾病严重程度的另一个重要标志物。
