Estenose aórtica severa em idosos: avaliação clínica, eletrocardiográfica, ecocardiográfica e angiográfica

Sá, Michel Pompeu Barros de Oliveira; Gomes, Rafael Alessandro Ferreira; Calado Filho, Ivaldo; Medeiros, Angela; Gonçalves, Aarão

doi:10.1590/1809-9823.200912015

Resumo

Objetivos:

Analisar o perfil clínico e laboratorial de idosos portadores de estenose aórtica severa e possíveis diferenças entre os sexos.

Método:

Foram estudados 30 pacientes (18 homens e 12 mulheres), com média de idade de 70,7±5,3 anos, portadores de estenose aórtica acentuada, sendo avaliados quanto a sintomas clínicos, presença de fatores de risco, padrões eletrocardiográficos, ecocardiográficos e associação com doença arterial coronariana, pela realização de angiografia coronariana.

Resultados:

Dispnéia foi o sintoma mais frequente (40%). Mulheres tinham mais angina que os homens. Apenas dois pacientes tinham fração de ejeção baixa. Homens apresentaram menores frações de ejeção que mulheres (p<0,05). Houve alta prevalência (53,3%) de doença arterial coronariana associada através de coronariografia.

Conclusões:

Os achados de dispnéia como sintoma mais frequente no grupo total, diferença da frequência de sintomas entre os sexos e fração de ejeção menor nos homens sugeriram que os mecanismos de adaptação ventricular à estenose aórtica possam ser diferentes entre os sexos. Existe forte associação entre estenose aórtica senil calcificada e doença arterial coronariana em idosos.

Palavras-chave:
Perfil de Saúde; Idoso; Saúde do Idoso; Estenose da Valva Aórtica; Razão de Chances; Gênero e Saúde

Abstract

Objectives:

To evaluate clinical and laboratorial profile in elderly patients with severe aortic stenosis and possible gender differences.

Method:

We studied 30 patients (18 males and 12 females) aged 70,7±5,3 years with severe aortic stenosis, analyzing clinical manifestations, risk factors, eletrocardiographic and ecocardiographic indexes and association with coronary artery disease by coronary angiographic assessment.

Results:

Dyspnea was the most frequent symptom with overall prevalence of 40%. Women had more angina than men. Ejection fraction was low in only two patients. Male patients had lower ejection fraction (p<0,05). High prevalence (53,3%) of associated coronary artery disease was observed. Conclusions: Data showed dyspnea as the most common clinical manifestation, gender differences of clinical manifestations and lower ejection fraction in male patients suggest that adaptive mechanisms to this condition may be different in both genders. There is a strong association between aortic stenosis in elderly and coronary artery disease.

Key words:
Health Profile; Aged; Health of the Elderly; Aortic Valve Stenosis; Odds Ratio; Gender and Health

Texto completo disponível apenas em PDF. Full text available only in PDF format.

REFERÊNCIAS

¹
Vital and health statistics, series 13. National Center for Health Statistics 2005;127.
²
Selzer A. Changing aspects of the natural history of valvular aortic stenosis. N Engl J Med 1987;317:91-8.
³
Stewart BF, Siscovick D, Lind BK, et al. Clinical factors associated with calcific aortic valve disease. J Am Coll Cardiol 1997;29:630-4.
⁴
Lindroos M, Kupari M, Heikkila J, Tilvis R. Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample. J Am Coll Cardiol 1993;21:1220-5.
⁵
Deutscher S, Rockette HE, Krishnaswami V. Diabetes and hypercholesterolemia among patients with calcific aortic stenosis. J Chronic Dis 1984;37:407-15.
⁶
Aronow WS, Kronzon I. Correlation of prevalence and severity of valvular aortic stenosis determined by continuous-wave Doppler echocardiography with physical signs of aortic stenosis in patients aged 62 to 100 years with aortic systolic ejection murmurs. Am J Cardiol 1987;60:399-401.
⁷
Mohler ER, Sheridan MJ, Nichols R, Harvey WP, Waller BF. Development and progression of aortic valve stenosis: atherosclerosis risk factors-a causal relationship? A clinical morphologic study. Clin Cardiol 1991;14:995-9.
⁸
Gotoh T, Kuroda T, Yamasawa M, et al. Correlation between lipoprotein(a) and aortic valve sclerosis assessed by echocardiography (the JMS cardiac echo and cohort study). Am J Cardiol 1995;76:928-32.
⁹
Julius BK, Spillmann M, Vassalli G, Villari B , Eberli FR, Hess OM. Angina pectoris in patients with aortic stenosis and normal coronary arteries. Mechanisms and pathophysiological concepts. Circulation 1997;95:892-8.
¹⁰
Marcus ML, Doty DB, Hiratzka LF, Wright CB, Eastham CL. Decreased coronary reserve: a mechanism for angina pectoris in patients with aortic stenosis and normal coronary arteries. N Engl J Med 1982;307:1362-6.
¹¹
Lombard JT, Selzer A. Valvular aortic stenosis. A clinical and hemodynamic profile of patients. Ann Intern Med 1987;106:292-8.
¹²
Richards AM, Nicholls MG, Ikram H, Hamilton EJ, Richards RD. Syncope in aortic valvular stenosis. The Lancet. 1984;2:1113-6.
¹³
Pluta W, Buszman P, Lekston A, Pasyk S. Coronary artery stenosis in pacients with vascular heart disease. Cor Vasa 1989;31:451-7.
¹⁴
Mauter GC, Roberts WC. Reported frequency of coronary arterial narrowing by angiogram in patient with valvular aortic stenosis. Am J Cardiol 1992;69:539-40.
¹⁵
Rangel MC, Grinberg M, Maranhão RC, Ventura LI. Estenose aórtica e doença coronariana. Análise dos fatores de risco. Arq Bras Cardiol 2006;87:115-20.
¹⁶
Vekshtein VI, Alexander RW, Yeung AC, Plappert T, St John Sutton MG, Ganz P et al. Coronary atherosclerosis is associated with left ventricular dysfunction and dilatation in aortic stenosis. Circulation 1990;82: 2068-74.
¹⁷
Bessone LN, Pupello DF, Hiro SP, Lopez-Cuenca E, Glatterer MS, Ebra G. Surgical management of aortic valve disease in the elderly : a longitudinal analysis. Ann Thorac Surg 1988;.46:264-9.
¹⁸
Vandeplas A, Willems JL, Piessens J, de Geest H. Frequency of angina pectoris and coronary artery disease in severe isolated valvular aortic stenosis. Am J Cardiol 1988;62: 117-20.
¹⁹
Sheiban J, Trevi GP, Benussi P, Marini A, Accardi R.; Di Bona E et al. Incidence of coronary artery disease in patients with valvular heart disease. Z Kardiol 1986;75(Suppl 2):76-9.
²⁰
Ramsdale DR, Bennett DH, Bray CL, Ward C, Beton DC, Faragher EB. Angina, coronary risk factors and coronary artery disease in patients with valvular disease. A prospective study. Eur Heart J 1984;5:716-27.
²¹
Sokolow M, Lyon T P. Eletrocardiographic diagnosis of left vntricular hypertrophy as obtained by unipolar, precordial and limbs leads. Am Heart J 1949; 37: 161-4.
²²
Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P. Improved sexspecific criteria of left ventricular Hypetrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation 1987; 75: 565-72.
²²
Devereux RB, Alonso DR, Lutas EM, et al. Echocardiografic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986; 57: 450-8.
²³
Tribouilloy C, Shen WF, Peltier M, et al. Quantitation of aortic valve area in aortic stenosis with multiplane transesophageal echocardiography: comparison with monoplane transesophageal approach. Am Heart J 1994; 128: 526.
²⁴
Aronow W S, Tresch D D, Nanna M . Aortic valve disease in the elderly. In: Tresch DD, Aronow WS, editors. Cardiovascular disease in the elderly patient. New York: Marcel Dekker, 1994: 345-72.
²⁵
Braunwald E. Valvular heart disease. In: Braunwald E., editors. A textbook of cardiovascular medicine. 7th ed. Philadelphia: WB Saunders; 2006. p. 1007-77.
²⁶
Kelly DT. Assessment of aortic stenosis in the elderly. Cardiology in the Elderly 1995; 3: 159-60.
²⁷
Roger VL, Tajib AJ, Bailey KR et al - Progression of aortic stenosis em adults: new appraisal using Dopplerechocardiography. Am Heart J 1990; 119: 331-8.
²⁸
Zak R. Factors contralling cardiac growth. In: Zak R. Growth of the heart and disease. New York: Ravin Press; 1984. p. 165-85.
²⁹
Grossman W. Cardiac hypertrophy: useful adaptation or pathologic press? Am J Med 1980; 69: 576-84.
³⁰
Carabello BA, Gren LH, Grossman W. Hemodynamic determinants of prognosis of aortic valve replacemente in critical aortic stenosis and advanced congestive heart failure. Circulation 1980; 62: 42-8.
³¹
Nunley DL, Grunkemerer GL, Starr A. Aortic valve replacement with coronary bypass grafting. J Thorac Cardiovasc Surg 1983;85:705-11.
³²
Reber PAD, Safir DO, Guadalajara JF - Estenosis aortica calcificada, semiologia y aspectos diagnosticos no invasivos en el anciano. Arch Inst Cardiol Mex 1986; 56: 41-7.
³³
Fleg JL . Eletrocardiographic findings in older persons without clinical heart disiase. In: Tresch DD, Aronow WS, editors. Cardiovascular disease in the elderly patients. New York: Marcel Dekker; 1994. p 43-59.
³⁴
Tresch DD. Atypic presentations of cardiovascular disorders in the elderly. Geriatrics 1987; 42: 31-46.
³⁵
Roberts WC. The senile calcification syndrome. Am J Cardiol 1986; 58: 372-3.
³⁶
Aronow WS, Schwatz KS, Koenigsberg M. Correlation of serum lipids, calcium and phosphorus, diabetes mellitus, aortic valve stenosis and history of systemic hypertension with presence or absence of mitral anular calcium in persons older than 62 years in long-term health care facility. Am J Cardiol 1987; 59: 381-2.
³⁷
Carroll JD, Carroll EP, Feldman T et al - Sex associated differences in left ventricular function in aortic stenosis of the elderly. Circulation 1992; 86: 1099- 107.
³⁸
Acar J, Vahanian A, Dicimetiere PH, Berdah J, Aouate PH, Sienczewski JA et al. Should coronary arteriography be performed in all patients who undergo catheterization for valvular heart disease? Z Kardiol 1986;75(Suppl 2):53-60.

Datas de Publicação

Publicação nesta coleção
Jan-Apr 2009

Histórico

Recebido
21 Jan 2008
Aceito
26 Ago 2008

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Vital and health statistics, series 13. National Center for Health Statistics 2005;127.

[2] ²
Selzer A. Changing aspects of the natural history of valvular aortic stenosis. N Engl J Med 1987;317:91-8.

[3] ³
Stewart BF, Siscovick D, Lind BK, et al. Clinical factors associated with calcific aortic valve disease. J Am Coll Cardiol 1997;29:630-4.

[4] ⁴
Lindroos M, Kupari M, Heikkila J, Tilvis R. Prevalence of aortic valve abnormalities in the elderly: an echocardiographic study of a random population sample. J Am Coll Cardiol 1993;21:1220-5.

[5] ⁵
Deutscher S, Rockette HE, Krishnaswami V. Diabetes and hypercholesterolemia among patients with calcific aortic stenosis. J Chronic Dis 1984;37:407-15.

[6] ⁶
Aronow WS, Kronzon I. Correlation of prevalence and severity of valvular aortic stenosis determined by continuous-wave Doppler echocardiography with physical signs of aortic stenosis in patients aged 62 to 100 years with aortic systolic ejection murmurs. Am J Cardiol 1987;60:399-401.

[7] ⁷
Mohler ER, Sheridan MJ, Nichols R, Harvey WP, Waller BF. Development and progression of aortic valve stenosis: atherosclerosis risk factors-a causal relationship? A clinical morphologic study. Clin Cardiol 1991;14:995-9.

[8] ⁸
Gotoh T, Kuroda T, Yamasawa M, et al. Correlation between lipoprotein(a) and aortic valve sclerosis assessed by echocardiography (the JMS cardiac echo and cohort study). Am J Cardiol 1995;76:928-32.

[9] ⁹
Julius BK, Spillmann M, Vassalli G, Villari B , Eberli FR, Hess OM. Angina pectoris in patients with aortic stenosis and normal coronary arteries. Mechanisms and pathophysiological concepts. Circulation 1997;95:892-8.

[10] ¹⁰
Marcus ML, Doty DB, Hiratzka LF, Wright CB, Eastham CL. Decreased coronary reserve: a mechanism for angina pectoris in patients with aortic stenosis and normal coronary arteries. N Engl J Med 1982;307:1362-6.

[11] ¹¹
Lombard JT, Selzer A. Valvular aortic stenosis. A clinical and hemodynamic profile of patients. Ann Intern Med 1987;106:292-8.

[12] ¹²
Richards AM, Nicholls MG, Ikram H, Hamilton EJ, Richards RD. Syncope in aortic valvular stenosis. The Lancet. 1984;2:1113-6.

[13] ¹³
Pluta W, Buszman P, Lekston A, Pasyk S. Coronary artery stenosis in pacients with vascular heart disease. Cor Vasa 1989;31:451-7.

[14] ¹⁴
Mauter GC, Roberts WC. Reported frequency of coronary arterial narrowing by angiogram in patient with valvular aortic stenosis. Am J Cardiol 1992;69:539-40.

[15] ¹⁵
Rangel MC, Grinberg M, Maranhão RC, Ventura LI. Estenose aórtica e doença coronariana. Análise dos fatores de risco. Arq Bras Cardiol 2006;87:115-20.

[16] ¹⁶
Vekshtein VI, Alexander RW, Yeung AC, Plappert T, St John Sutton MG, Ganz P et al. Coronary atherosclerosis is associated with left ventricular dysfunction and dilatation in aortic stenosis. Circulation 1990;82: 2068-74.

[17] ¹⁷
Bessone LN, Pupello DF, Hiro SP, Lopez-Cuenca E, Glatterer MS, Ebra G. Surgical management of aortic valve disease in the elderly : a longitudinal analysis. Ann Thorac Surg 1988;.46:264-9.

[18] ¹⁸
Vandeplas A, Willems JL, Piessens J, de Geest H. Frequency of angina pectoris and coronary artery disease in severe isolated valvular aortic stenosis. Am J Cardiol 1988;62: 117-20.

[19] ¹⁹
Sheiban J, Trevi GP, Benussi P, Marini A, Accardi R.; Di Bona E et al. Incidence of coronary artery disease in patients with valvular heart disease. Z Kardiol 1986;75(Suppl 2):76-9.

[20] ²⁰
Ramsdale DR, Bennett DH, Bray CL, Ward C, Beton DC, Faragher EB. Angina, coronary risk factors and coronary artery disease in patients with valvular disease. A prospective study. Eur Heart J 1984;5:716-27.

[21] ²¹
Sokolow M, Lyon T P. Eletrocardiographic diagnosis of left vntricular hypertrophy as obtained by unipolar, precordial and limbs leads. Am Heart J 1949; 37: 161-4.

[22] ²²
Casale PN, Devereux RB, Alonso DR, Campo E, Kligfield P. Improved sexspecific criteria of left ventricular Hypetrophy for clinical and computer interpretation of electrocardiograms: validation with autopsy findings. Circulation 1987; 75: 565-72.

[23] ²²
Devereux RB, Alonso DR, Lutas EM, et al. Echocardiografic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986; 57: 450-8.

[24] ²³
Tribouilloy C, Shen WF, Peltier M, et al. Quantitation of aortic valve area in aortic stenosis with multiplane transesophageal echocardiography: comparison with monoplane transesophageal approach. Am Heart J 1994; 128: 526.

[25] ²⁴
Aronow W S, Tresch D D, Nanna M . Aortic valve disease in the elderly. In: Tresch DD, Aronow WS, editors. Cardiovascular disease in the elderly patient. New York: Marcel Dekker, 1994: 345-72.

[26] ²⁵
Braunwald E. Valvular heart disease. In: Braunwald E., editors. A textbook of cardiovascular medicine. 7th ed. Philadelphia: WB Saunders; 2006. p. 1007-77.

[27] ²⁶
Kelly DT. Assessment of aortic stenosis in the elderly. Cardiology in the Elderly 1995; 3: 159-60.

[28] ²⁷
Roger VL, Tajib AJ, Bailey KR et al - Progression of aortic stenosis em adults: new appraisal using Dopplerechocardiography. Am Heart J 1990; 119: 331-8.

[29] ²⁸
Zak R. Factors contralling cardiac growth. In: Zak R. Growth of the heart and disease. New York: Ravin Press; 1984. p. 165-85.

[30] ²⁹
Grossman W. Cardiac hypertrophy: useful adaptation or pathologic press? Am J Med 1980; 69: 576-84.

[31] ³⁰
Carabello BA, Gren LH, Grossman W. Hemodynamic determinants of prognosis of aortic valve replacemente in critical aortic stenosis and advanced congestive heart failure. Circulation 1980; 62: 42-8.

[32] ³¹
Nunley DL, Grunkemerer GL, Starr A. Aortic valve replacement with coronary bypass grafting. J Thorac Cardiovasc Surg 1983;85:705-11.

[33] ³²
Reber PAD, Safir DO, Guadalajara JF - Estenosis aortica calcificada, semiologia y aspectos diagnosticos no invasivos en el anciano. Arch Inst Cardiol Mex 1986; 56: 41-7.

[34] ³³
Fleg JL . Eletrocardiographic findings in older persons without clinical heart disiase. In: Tresch DD, Aronow WS, editors. Cardiovascular disease in the elderly patients. New York: Marcel Dekker; 1994. p 43-59.

[35] ³⁴
Tresch DD. Atypic presentations of cardiovascular disorders in the elderly. Geriatrics 1987; 42: 31-46.

[36] ³⁵
Roberts WC. The senile calcification syndrome. Am J Cardiol 1986; 58: 372-3.

[37] ³⁶
Aronow WS, Schwatz KS, Koenigsberg M. Correlation of serum lipids, calcium and phosphorus, diabetes mellitus, aortic valve stenosis and history of systemic hypertension with presence or absence of mitral anular calcium in persons older than 62 years in long-term health care facility. Am J Cardiol 1987; 59: 381-2.

[38] ³⁷
Carroll JD, Carroll EP, Feldman T et al - Sex associated differences in left ventricular function in aortic stenosis of the elderly. Circulation 1992; 86: 1099- 107.

[39] ³⁸
Acar J, Vahanian A, Dicimetiere PH, Berdah J, Aouate PH, Sienczewski JA et al. Should coronary arteriography be performed in all patients who undergo catheterization for valvular heart disease? Z Kardiol 1986;75(Suppl 2):53-60.

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