Sekiya M, Mukai M, Suzuki M, Ohtani T, Abe M, Matsuoka H, Sumimoto T, Fujiwara Y, Hamada M, Hiwada K
Second Department of Internal Medicine, Ehime University School of Medicine, Japan.
Angiology. 1992 May;43(5):401-7. doi: 10.1177/000331979204300505.
In order to clarify the clinical significance of coronary calcification in patients with angiographically normal coronary arteries, exercise electrocardiography was used and left ventricular function was examined noninvasively and invasively. The patient groups were as follows: (1) patients with coronary artery calcification on only the left anterior descending artery but no narrowing lesion on any other arteries (calcified group), (2) patients with a significant stenosis on only the left anterior descending artery (stenotic group), and (3) the control group. The left ventricular function in the calcified group, as indicated by systolic time intervals and invasive parameters such as ejection fraction and mean systolic ejection rate, showed a depression similar to that in the stenotic group, compared with the control group. The incidence of electrocardiographically ischemic responses to exercise testing was significantly higher in the calcified group (75%, p less than 0.01) and the stenotic group (68%, p less than 0.01) than in the control group (25%). Exercise tolerance time and the maximum double product were markedly smaller in the calcified and the stenotic groups as compared with the control group. These results indicate that the left ventricular function and coronary reserve in the calcified group were reduced and almost identical with those in the stenotic group. The authors conclude that a calcified coronary artery, even if patent, cannot supply an adequate blood flow for the myocardium, resulting in impaired left ventricular function.
为了阐明冠状动脉造影正常的患者中冠状动脉钙化的临床意义，采用了运动心电图检查，并对左心室功能进行了无创和有创检查。患者分组如下：（1）仅左前降支有冠状动脉钙化但其他动脉无狭窄病变的患者（钙化组），（2）仅左前降支有明显狭窄的患者（狭窄组），以及（3）对照组。与对照组相比，钙化组的左心室功能，以收缩时间间期和诸如射血分数及平均收缩射血率等有创参数表示，显示出与狭窄组相似的降低。钙化组（75%，p<0.01）和狭窄组（68%，p<0.01）运动试验心电图缺血反应的发生率显著高于对照组（25%）。与对照组相比，钙化组和狭窄组的运动耐量时间和最大心率血压乘积明显更小。这些结果表明，钙化组的左心室功能和冠状动脉储备降低，且与狭窄组几乎相同。作者得出结论，即使冠状动脉钙化但通畅，也不能为心肌提供足够的血流，从而导致左心室功能受损。
