Hancock E W
Am Heart J. 1977 Mar;93(3):382-93. doi: 10.1016/s0002-8703(77)80259-7.
The relationships between aortic stenosis, coronary artery disease, angina pectoris, and myocardial infarction were examined in 173 patients with isolated calcific aortic stenosis who had coronary arteriography as well as cardiac catheterization. All were over age 40 and had definite cardiac symptoms; 156 later had aortic valve replacement. Coronary lesions narrowing the lumen by 50% or more were present in 37% of patients aged 40 to 59 and 68% of those aged 60 to 82. Coronary disease was present in 64% of patients with angina pectoris and 33% of those without angina. Angina which occurred only in association with dyspnea on exertion was associated with coronary disease in 45% of instances, whereas angina which also occurred on exertion without any dyspnea or which occurred with emotional stress, after meals, during sleep, or at rest unprovoked was associated with coronary disease in 80% of instances. Patients with coronary disease without any chest pain or with atypical pain considered nonanginal were men, usually over age 60, with congestive heart failure as the predominant symptom. Electrocardiograms showing transmural inferior or anterolateral infarction nearly always indicated coronary disease, while QS patterns in Leads V1-2 occurred frequently with normal coronary arteries. Serum cholesterol was elevated in 23% of those with coronary disease and 8% of those without. A group of patients with moderate aortic stenosis could be identified, with aortic valve areas of 0.55 to 0.80 cm. per square meter, in whom coronary disease was the sole or chief cause of symptoms. The operative mortality rate with aortic valve replacement was 9.6% in those with coronary disease and 1.4% in those without significant coronary disease. Coronary disease is frequently present in patients with calcific aortic stenosis, particularly in those over 60, those with angina, and those with symptoms despite only moderate aortic stenosis. The type of anginal syndrome, the ECG evidence of transmural infarction, and the coronary risk factors provide additional clues for clinical diagnosis.
对173例患有单纯钙化性主动脉瓣狭窄且接受了冠状动脉造影和心导管检查的患者，研究了主动脉瓣狭窄、冠状动脉疾病、心绞痛和心肌梗死之间的关系。所有患者年龄均超过40岁且有明确的心脏症状；156例患者后来接受了主动脉瓣置换术。40至59岁的患者中，37%存在使管腔狭窄50%或更多的冠状动脉病变，60至82岁的患者中这一比例为68%。心绞痛患者中64%患有冠状动脉疾病，无心绞痛患者中这一比例为33%。仅在劳力性呼吸困难时出现的心绞痛，45%的病例与冠状动脉疾病有关；而在无任何呼吸困难的劳力时、情绪应激时、餐后、睡眠中或无诱因休息时出现的心绞痛，80%的病例与冠状动脉疾病有关。患有冠状动脉疾病但无胸痛或有非心绞痛性非典型疼痛的患者为男性，通常年龄超过60岁，以充血性心力衰竭为主要症状。显示透壁性下壁或前侧壁梗死的心电图几乎总是提示冠状动脉疾病，而V1 - 2导联出现QS波型在冠状动脉正常时也很常见。患有冠状动脉疾病的患者中23%血清胆固醇升高，无冠状动脉疾病的患者中这一比例为8%。可以识别出一组中度主动脉瓣狭窄患者，其主动脉瓣面积为每平方米0.55至0.80平方厘米，冠状动脉疾病是其症状的唯一或主要原因。患有冠状动脉疾病的患者接受主动脉瓣置换术的手术死亡率为9.6%，无明显冠状动脉疾病的患者为1.4%。钙化性主动脉瓣狭窄患者中经常存在冠状动脉疾病，尤其是60岁以上、有心绞痛以及尽管主动脉瓣狭窄程度仅为中度但仍有症状的患者。心绞痛综合征的类型、透壁梗死的心电图证据以及冠状动脉危险因素为临床诊断提供了额外线索。
