Lambert C R, Conti C R, Pepine C J
Cardiol Clin. 1986 Nov;4(4):669-75.
A large body of evidence exists indicating that left ventricular dysfunction is a common occurrence in patients with severe coronary artery disease and represents silent or asymptomatic myocardial ischemia. Such dysfunction probably occurs early in the time course of every ischemic episode in patients with coronary artery disease whether symptoms are eventually manifested or not. The pathophysiology of silent versus symptomatic left ventricular dysfunction due to ischemia appears to be identical. Silent ischemia-related left ventricular dysfunction can be documented during spontaneous or stress-induced perturbations in the myocardial oxygen supply/demand ratio. It also may be detected by nitroglycerin-induced improvement in ventricular function or by salutary changes in wall motion following revascularization. Silent left ventricular dysfunction is a very early occurrence during ischemia and precedes electrocardiographic abnormalities. In this light, its existence should always be kept in mind when dealing with patients with ischemic heart disease. It can be hypothesized that because silent ischemia appears to be identical to ischemia with symptoms in a pathophysiologic sense, prognosis and treatment in both cases should be the same.
大量证据表明，左心室功能障碍在严重冠状动脉疾病患者中很常见，代表着无症状或隐匿性心肌缺血。这种功能障碍可能在冠心病患者每次缺血发作的早期就已出现，无论最终是否出现症状。缺血导致的无症状与有症状左心室功能障碍的病理生理学似乎是相同的。在心肌氧供/需求比的自发或应激诱导扰动期间，可以记录到与无症状缺血相关的左心室功能障碍。它也可以通过硝酸甘油诱导的心室功能改善或血运重建后壁运动的有益变化来检测。无症状左心室功能障碍在缺血过程中很早就会出现，且早于心电图异常。鉴于此，在处理缺血性心脏病患者时应始终牢记其存在。可以推测，由于在病理生理学意义上无症状缺血似乎与有症状缺血相同，因此这两种情况下的预后和治疗应该相同。
