Gahl K, Sutton R, Pearson M, Caspari P, Lairet A, McDonald L
Br Heart J. 1977 Jan;39(1):13-8. doi: 10.1136/hrt.39.1.13.
Mitral reguritation is a relatively common finding in coronary heart disease. In this series of 127 patients, selected with a view to coronary or left ventricular surgery on the basis of severity of symptoms, the incidence was 39 (31%). Mitral regurgitation is significantly more common in patients with a history or electrocardiographic evidence of previous myocardial infarction. Clinically it may present as a pan- or late systolic or even a mid-systolic, ejection type murmur at the apex or at the left sternal edge; but in 39 per cent of the patients with angiographic mitral regurgitation no murmur was present. Angiographically important mitral regurgitation (grades 2-4/4) was usually associated with a systolic murmur; this finding was independent of ejection fractions. Left ventricular enlargement clinically or radiographically is likely to accompany mitral regurgitation but left atrial enlargement (electrocardiographically or on chest x-ray) is a more reliable pointer to mitral regurgitation and pulmonary venous hypertension is even more strongly suggestive of its presence. The electrocardiographic signs of papillary muscle infarction were rare in this series (15%) and were not related to angiographic mitral regurgitation. There was no difference in the incidence of mitral regurgitation in association with anterior or inferior myocardial infarction or in distribution of coronary artery disease. There is, however, a higher incidence of mitral regurgitation in more severe coronary arterial disease (P less than 0-05). The incidence of mitral regurgitation is significantly higher with reduction in left ventricular ejection fraction (P less than 0-001), with rise in the left ventricular end-diastolic pressure (P less than 0-02), and with abnormal contraction patterns, but the severity of mitral regurgitation is not significantly related to these findings.
二尖瓣反流在冠心病中是一种相对常见的表现。在这组127例根据症状严重程度入选拟行冠状动脉或左心室手术的患者中，二尖瓣反流的发生率为39例（31%）。二尖瓣反流在有既往心肌梗死病史或心电图证据的患者中明显更为常见。临床上，它可能表现为心尖部或左胸骨缘全收缩期、晚期收缩期甚至中期收缩期喷射样杂音；但在39%的经血管造影证实有二尖瓣反流的患者中未闻及杂音。血管造影显示有重要意义的二尖瓣反流（2 - 4/4级）通常伴有收缩期杂音；这一发现与射血分数无关。临床上或影像学上左心室增大可能伴随二尖瓣反流，但左心房增大（心电图或胸部X线表现）是二尖瓣反流更可靠的指标，而肺静脉高压更强烈提示其存在。在这组患者中，乳头肌梗死的心电图表现很少见（15%），且与血管造影显示的二尖瓣反流无关。与前壁或下壁心肌梗死相关的二尖瓣反流发生率以及冠状动脉疾病的分布情况没有差异。然而，在更严重的冠状动脉疾病中二尖瓣反流的发生率更高（P < 0.05）。二尖瓣反流的发生率在左心室射血分数降低（P < 0.001）、左心室舒张末期压力升高（P < 0.02）以及收缩模式异常时显著升高，但二尖瓣反流的严重程度与这些发现无显著相关性。
