C-Reactive Protein in Predicting Coronary Artery Disease in Subjects with Aortic Valve Sclerosis Before Diagnostic Coronary Angiography

Abstract

Although previous studies have suggested that aortic valve sclerosis (AVS) shares common histologic features with atherosclerosis and is an indicator of significant coronary artery disease (CAD), many patients with aortic valve disease do not have coexisting coronary atherosclerotic disease and vice versa. It is important to find the subjects with AVS who are most likely to have concomitant CAD and require aggressive evaluation. We hypothesized that the systemic inflammatory marker, high-sensitive C-reactive protein (hs-CRP), may be associated with AVS, and may be helpful before coronary angiography in identifying the presence of concomitant CAD in patients with AVS. This study included 227 patients with suspected CAD undergoing transthoracic echocardiography and coronary angiography. AVS was defined as a focal area of increased echogenicity and thickening of the aortic valve leaflets without restriction in motion. Data of atherosclerotic risk factors including hs-CRP were collected. Technically satisfactory ultrasound recordings were obtained in 217 subjects (96% of enrolled patients). Patients with AVS were older (65+/-10 vs. 60+/-10 years old; P=0.0004), had higher serum creatinine levels (115.2+/-79.7 vs. 88.6 +/-35.4 micromol/L; P=0.04), and had greater prevalence of obstructive CAD (75% vs. 53%; P=0.001) than those with normal aortic valves. CRP levels were not associated with AVS, and failed to predict concomitant CAD in patients with AVS. Additionally, none of the established risk factors were independent predictors of the presence of CAD in AVS patients. Hs-CRP levels appear to not be associated with AVS, and are of little value in terms of predicting the presence of concurrent CAD before coronary procedure.