Thompson R H, Ahmed M S, Mitchell A G, Towers M K, Yacoub M H
Clin Cardiol. 1979 Feb;2(1):26-32. doi: 10.1002/clc.4960020105.
The pre-operative clinical and haemodynamic findings of 139 consecutive patients with aortic stenosis were analysed in an attempt to determine the incidence and influence of coronary heart disease on the mode of presentation of patients with aortic stenosis. The overall incidence of coronary heart disease was 32%. 105 patients (76%) presented with angina and of these, 41 patients (39%) had significant coronary heart disease as compared to 4 (13%) of the remaining 34 patients who did not present with angina. Clinical parameters including age, sex, severity of angina together with the presence of associated symptoms and precipitating factors were unhelpful in distinguishing those patients with coronary heart disease. Evidence of previous transmural myocardial infarction or the presence of ST-T abnormalities in the absence of digitalis and the changes of left ventricular hypertrophy were reliable electrocardiographic signs of coronary heart disease. Although peak systolic aortic valve gradient tended to decrease with increasing severity of coronary heart disease, the severity of aortic stenosis was not a reliable indicator of the presence of coronary disease. Patients with coronary heart disease in the absence of angina all had a combination of moderate aortic stenosis and single vessel disease. It is concluded that coronary heart disease cannot be predicted in patients with angina and, in the absence of angina occurs with an incidence sufficiently high to advocate the use of coronary angiography as part of the investigation of all patients with aortic stenosis being considered for valve replacement.
对139例连续性主动脉瓣狭窄患者的术前临床和血流动力学结果进行了分析，以确定冠心病的发病率及其对主动脉瓣狭窄患者表现形式的影响。冠心病的总体发病率为32%。105例（76%）患者出现心绞痛，其中41例（39%）患有严重冠心病，相比之下，其余34例未出现心绞痛的患者中有4例（13%）患有严重冠心病。包括年龄、性别、心绞痛严重程度以及相关症状和诱发因素在内的临床参数，在区分冠心病患者方面并无帮助。既往透壁心肌梗死的证据，或在无洋地黄及左心室肥厚改变的情况下出现ST-T异常，是冠心病可靠的心电图表现。虽然随着冠心病严重程度的增加，收缩期主动脉瓣峰值梯度有下降趋势，但主动脉瓣狭窄的严重程度并非冠心病存在的可靠指标。无心绞痛的冠心病患者均合并中度主动脉瓣狭窄和单支血管病变。得出的结论是，心绞痛患者无法预测是否患有冠心病，而在无心绞痛的情况下，冠心病的发病率高到足以提倡将冠状动脉造影作为所有考虑进行瓣膜置换的主动脉瓣狭窄患者检查的一部分。
