Shafi Shahida, Aouabdi Sihem, Taher Ziad A, Alghamdi Abdulrahman E, Ahmed Mohammed A, Ahmed Fatima A, Alghamdi Suliman, Haneef Ali
Department of Cardiology, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.
Department of Regenerative Medicine, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU.
Cureus. 2024 Mar 31;16(3):e57317. doi: 10.7759/cureus.57317. eCollection 2024 Mar.
The paradox of concurrent coronary artery disease (CAD) among patients with rheumatic and non-rheumatic valvular heart disease (RVHD; non-RVHD) is unclear. We aimed to evaluate the impact of the RVHD and non-RVHD on the prevalence of CAD and various risk factors, assess the number of diseased coronaries, clinical profile and the possible predictors of CAD in these patients, which may clarify the paradox and provide an insight for the prevention of CAD.
The records of 106 valvular heart disease patients who had undergone valve replacement surgery at the King Faisal Cardiac Centre from January 2014 to October 2019 were evaluated. The clinical data and established risk factors were compared and logistic regression analyses were performed to identify plausible predictors of CAD.
Transthoracic echocardiographic diagnosis of 106 patients confirmed, 43 had RVHD (56.4 ± 8 years), of whom six (13.9%) had CAD with the highest mitral valve regurgitation ( < 0.01), and 63 had non-RVHD (60.0 ± 12 years). Of these, 31 patients showed the highest CAD (49.2%). Single- and triple-vessel disease was most common in RVHD and non-RVHD patients with concurrent CAD (33.3%; 41.9%, respectively), while non-RVHD patients also had quadruple vessel disease. The mean age of the RVHD and non-RVHD patients with coexisting CAD was significantly higher (66.7 ± 5; 66.7 ± 8 years) than those without CAD (46.1 ± 12.0; 54.7 ± 20, respectively). RVHD patients showed a significantly lower prevalence of diabetes, dyslipidaemia, hypertension, inflammatory cells, hepatorenal function markers, ejection fraction, and regional wall motion abnormality compared to RVHD patients with coexisting CAD (p < 0.01). Bivariate analysis indicated white blood cells, monocytes, neutrophils, gamma-glutamyl-transferase (GGT), bilirubin and blood urea nitrogen (BUN) to be significantly lower in RVHD patients. Predictors of high risk of CAD were BUN and hyperlipidaemia for RVHD and BUN, creatinine and GGT for non-RVHD patients.
The prevalence of CAD in Saudi RVHD patients was significantly lower than in the Western countries, whereas non-RVHD was higher. The low prevalence may partly be attributed to age, reduced mitral regurgitation, and low frequency of risk and inflammatory factors.
风湿性和非风湿性瓣膜性心脏病（RVHD；非RVHD）患者并发冠状动脉疾病（CAD）的矛盾情况尚不清楚。我们旨在评估RVHD和非RVHD对CAD患病率及各种危险因素的影响，评估这些患者中患病冠状动脉的数量、临床特征以及CAD的可能预测因素，这可能会阐明这一矛盾情况，并为CAD的预防提供见解。
对2014年1月至2019年10月在费萨尔国王心脏中心接受瓣膜置换手术的106例瓣膜性心脏病患者的记录进行评估。比较临床数据和既定危险因素，并进行逻辑回归分析以确定CAD的合理预测因素。
经胸超声心动图诊断确诊的106例患者中，43例患有RVHD（56.4±8岁），其中6例（13.9%）患有CAD，二尖瓣反流程度最高（<0.01），63例患有非RVHD（60.0±12岁）。其中，31例患者CAD发生率最高（49.2%）。单支血管和三支血管病变在并发CAD的RVHD和非RVHD患者中最为常见（分别为33.3%；41.9%），而非RVHD患者也有四支血管病变。并发CAD的RVHD和非RVHD患者的平均年龄（分别为66.7±5岁；66.7±8岁）显著高于无CAD的患者（分别为46.1±12.0岁；54.7±20岁）。与并发CAD的RVHD患者相比，RVHD患者的糖尿病、血脂异常、高血压、炎症细胞、肝肾功能标志物、射血分数和室壁运动异常的患病率显著较低（p<0.01）。双变量分析表明，RVHD患者的白细胞、单核细胞、中性粒细胞、γ-谷氨酰转移酶（GGT）、胆红素和血尿素氮（BUN）显著较低。RVHD患者CAD高风险的预测因素是BUN和高脂血症，非RVHD患者是BUN、肌酐和GGT。
沙特RVHD患者CAD的患病率显著低于西方国家，而非RVHD患者则较高。患病率低可能部分归因于年龄、二尖瓣反流减少以及风险和炎症因素的频率较低。
