CLINICAL FACTORS USEFUL IN PREDICTING AORTIC-VALVE STRUCTURE IN PATIENTS GREATER-THAN-40 YEARS OF AGE WITH ISOLATED VALVULAR AORTIC-STENOSIS

A number of reports have described the frequency of coronary arterial narrowing in patients with valvular aortic stenosis. No published repo rts have examined the structure of the stenotic aortic valve in adults and related the valve structure to variables, including coronary arte rial narrowing, useful in predicting that structure. One hundred eight y-eight patients having aortic valve replacement for isolated valvular aortic stenosis were studied. All patients were >40 years of age at t he time of aortic valve replacement, all had coronary angiograms preop eratively, and of 182 patients (97%) measurements of serum total chole sterol had been obtained and 184 (98%) had body mass index calculated. The structure of the operatively excised valve was classified as unic uspid or bicuspid (congenitally malformed), or tricuspid aortic valve. A logistic regression model was developed that found 4 factors (age, serum total cholesterol, angiographic coronary artery disease and body mass index) to be predictive of aortic valve structure: (1) Patients with at least 3 or all 4 factors high or present (i.e., age >65 years, serum total cholesterol >200 mg/dl, body mass index >29 kg/m2 and cor onary artery disease) had a low probability (10 to 29%) of having a co ngenitally malformed valve; (2) patients with at least 3 or all 4 fact ors low or absent (i.e., age less-than-or-equal-to 65 years, serum tot al cholesterol less-than-or-equal-to 200 mg/dl, body mass index less-t han-or-equal-to 29 kg/m2, and no coronary artery disease) had a high p robability (72 to 90%) of having a congenitally malformed valve. Thus, the morphology of the operatively excised stenotic aortic valve can b e predicted with knowledge of the age, serum total cholesterol, body m ass index and coronary artery status of the patient.