Nylander E, Ekman I, Marklund T, Sinnerstad B, Karlsson E, Wranne B
Br Heart J. 1986 May;55(5):480-7. doi: 10.1136/hrt.55.5.480.
Clinical and non-invasive findings were compared with catheterisation data in 91 elderly patients (mean 65 years, range 52-78) with suspected severe aortic stenosis requiring operation. Heart catheterisation showed that forty nine patients had a valve area of less than or equal to 0.6 cm2, 36 had a valve area of 0.7 - 1.0 cm2, and six an area of greater than or equal to 1.1 cm2. Coexistent aortic regurgitation was found in 85% of the cases, but severe regurgitation was found in only one patient (1%). Seventy seven per cent of patients had chest pain, 74% had dyspnoea, and 46% had exertional vertigo or syncope. Coronary angiography, which was performed in 77 patients, showed coronary artery disease in 24% of those with a history of angina pectoris and in none of those without. All patients had echodense valves; aortic valve calcification was shown by x ray in 76% and in all but one by cineradiography. The peak of the systolic murmur was delayed in 98% of the patients. Although a prolonged left ventricular ejection time was characteristic of severe aortic stenosis, a normal value did not exclude this diagnosis. Most patients (84%) had increased QRS amplitude on the electrocardiogram. Echocardiography showed an increased left ventricular wall thickness in 90% of the patients in whom it was possible to define the myocardial borders. There was an inadequate blood pressure increase in response to exercise in 82%. In about 25% of the patients the exercise test was at variance with the New York Heart Association classification. Findings suggesting severe aortic stenosis resembled those reported for younger age groups. When most findings point to severe aortic stenosis, the absence of a single symptom or non-invasive sign does not exclude severe aortic stenosis.
对91例疑似重度主动脉瓣狭窄且需要手术的老年患者（平均年龄65岁，范围52 - 78岁）的临床及非侵入性检查结果与心导管检查数据进行了比较。心导管检查显示，49例患者的瓣膜面积小于或等于0.6平方厘米，36例患者的瓣膜面积为0.7 - 1.0平方厘米，6例患者的瓣膜面积大于或等于1.1平方厘米。85%的病例存在主动脉瓣反流，但只有1例患者（1%）存在重度反流。77%的患者有胸痛，74%的患者有呼吸困难，46%的患者有劳力性眩晕或晕厥。77例患者进行了冠状动脉造影，有胸痛病史的患者中24%显示有冠状动脉疾病，无胸痛病史的患者均未显示有冠状动脉疾病。所有患者的瓣膜回声增强；76%的患者X线显示主动脉瓣钙化，除1例患者外，所有患者的电影摄影均显示主动脉瓣钙化。98%的患者收缩期杂音峰值延迟。虽然左心室射血时间延长是重度主动脉瓣狭窄的特征，但正常数值并不能排除该诊断。大多数患者（84%）心电图上QRS波振幅增加。超声心动图显示，在90%能够明确心肌边界的患者中左心室壁厚度增加。82%的患者运动时血压升高不足。约25%的患者运动试验结果与纽约心脏病协会分级不一致。提示重度主动脉瓣狭窄的检查结果与较年轻年龄组报告的结果相似。当大多数检查结果指向重度主动脉瓣狭窄时，单一症状或非侵入性体征的缺失并不排除重度主动脉瓣狭窄。
