Yasue H, Takizawa A, Nagao M, Nishida S, Horie M, Kubota J, Fujii H
Am Heart J. 1986 Aug;112(2):263-72. doi: 10.1016/0002-8703(86)90260-7.
We examined the pathogenesis of angina pectoris in 101 patients with one-vessel disease except those with 99% to 100% occlusion. The attacks could not be induced or could not be reproducibly induced by maximal treadmill exercise at the same hour of different days within a week period in 54 (53.5%) of the patients. In the 47 patients whose attacks were reproducibly induced by the exercise, propranolol, 80 mg orally, did not suppress the attacks in 41 (87.2%) of the patients. Diltiazem, 90 mg, and nifedipine, 20 mg given orally, suppressed the attacks completely in 39 (83.0%) of the 47 patients and in 36 (81.8%) of the 44 patients, respectively. Coronary arteriography showed that dynamic obstruction of the artery supplying the area of myocardium represented by ST segment deviation appeared during the attacks and disappeared with subsidence of the attacks in all 55 patients in whom coronary arteriography was done during the attack. We conclude that angina pectoris is usually caused not by increased myocardial oxygen demand but by dynamic coronary obstruction or by a combination of both in most patients with one-vessel disease.
我们对101例单支血管病变患者（除了那些血管闭塞程度达99%至100%的患者）的心绞痛发病机制进行了研究。在54例（53.5%）患者中，一周内不同日期的同一时间进行最大量平板运动，无法诱发或无法重复诱发心绞痛发作。在47例运动可重复诱发发作的患者中，口服80毫克普萘洛尔未能抑制41例（87.2%）患者的发作。口服90毫克地尔硫䓬和20毫克硝苯地平，分别使47例患者中的39例（83.0%）和44例患者中的36例（81.8%）的发作完全得到抑制。冠状动脉造影显示，在发作期间，所有55例在发作时进行冠状动脉造影的患者中，供应以ST段偏移为代表的心肌区域的动脉出现动态阻塞，并随着发作缓解而消失。我们得出结论，在大多数单支血管病变患者中，心绞痛通常不是由心肌需氧量增加引起的，而是由冠状动脉动态阻塞或两者共同作用引起的。
