Prevalence of Coronary Artery Disease in Patients of Rheumatic Heart Disease

Background: Few studies have focused on the prevalence of CAD in RHD. Coronary angiography should be routinely done in patients of valvular heart disease prior to surgery, especially in patients above 40 years of age. Overlooking CAD can lead to complications and poor results in post-operative period of valvular surgery. Clinical symptoms are common in both CAD and RHD. Indian studies by V. Jacob Jose and Satya N Gupta have studied this aspect in detail and their results are quite different from Western literature.Material & Methods: This study was conducted in all patients of valvular heart disease (RHD) above 40 years of age. Apart from basic investigations and echocardiography, coronary angiogram was done in all patients and were evaluated for presence of CAD (significant ≥ 50% or insignificant). They were also evaluated for SVD/DVD or TVD and risk factors (hypertension, diabetes mellitus, dyslipidemia) and symptoms especially angina were correlated to the presence of CAD.Results: Out of the 100 patients of RHD from Jan 2008- June 2009 at PGIMER, Chandigarh, 38 were males and 62 were females. 12 had significant CAD, while 9 had non-significant CAD. Mean age for significant CAD was 52.58 years. Age distribution was statistically significant in the 51-60 year age group. 66 patients had mitral valve disease, 31 had combined mitral and aortic valve disease, while 3 had predominantly aortic valve disease. Angina was the only symptom which correlated with presence of CAD especially in aortic valve disease group, but p value was non-significant. In risk factor category, only hypertension and total cholesterol were statistically significant with CAD.Conclusion: Prevalence of significant CAD was 12%. 5 patients had SVD, 4 had DVD & 3 had TVD. 2 patients with MS, 4 with MS/MR, 4 with MV+AV and 2 with predominant aortic valve group had significant CAD. Angina was not found to be a useful clinical symptom to predict CAD. Hypertension and total cholesterol were the only risk factors which could be correlated with CAD in RHD group