Kaski J C, Rosano G M, Collins P, Nihoyannopoulos P, Maseri A, Poole-Wilson P A
St. George's Hospital Medical School, London, United Kingdom.
J Am Coll Cardiol. 1995 Mar 15;25(4):807-14. doi: 10.1016/0735-1097(94)00507-M.
Our aim was to study the clinical characteristics and evolution of symptoms and left ventricular function in a clinically homogeneous group of patients with syndrome X (angina pectoris, positive exercise test results and normal coronary arteriograms).
The syndrome of angina with normal coronary arteriograms is heterogeneous and encompasses different pathogenetic entities. These characteristics may contribute to the existing controversy concerning the cause of syndrome X.
We studied 99 patients with syndrome X (78 women, 21 men; mean age +/- SD 48.5 +/- 8 years). All underwent clinical characterization, ambulatory electrocardiographic (ECG) monitoring and echocardiographic assessment of left ventricular function during a follow-up period of 7 +/- 4 years.
The syndrome was more common in women than in men. Of the women, 61.5% were postmenopausal before the onset of chest pain. All 99 patients had exertional angina, and 41 also had rest angina. The average duration of episodes of chest pain was > 10 min in 53% of patients. Sublingual nitrate was effective for relief of pain in 42% of patients. Transient ST segment depression was observed during ambulatory ECG monitoring in 64 patients and myocardial perfusion abnormalities in 22. During the first stage of the exercise test, 32 patients had an increase > 20 mm Hg in systolic blood pressure and showed an earlier onset of ST depression and shorter exercise time than did patients whose blood pressure increased < or = 20%. During follow-up, no deaths or myocardial infarctions occurred, ventricular function was unchanged (shortening fraction 35.4 +/- 4% vs. 35.6 +/- 3%; heart failure developed in only one patient), systemic hypertension occurred in eight patients and conduction disturbances in four. Symptoms lessened in 11 patients, were variable or unchanged in 64 and worsened in 24.
Syndrome X, as defined in this study, occurs predominantly in postmenopausal women. Patients usually have chest pain typical for angina, but conventional antianginal treatment is not often successful. Myocardial perfusion abnormalities occur in a small proportion of patients. Long-term survival is not adversely affected, and deterioration of cardiac function rarely occurs.
我们的目的是研究一组临床特征均一的X综合征患者（心绞痛、运动试验结果阳性且冠状动脉造影正常）的临床特征、症状演变及左心室功能。
冠状动脉造影正常的心绞痛综合征具有异质性，包含不同的致病实体。这些特征可能导致了关于X综合征病因的现有争议。
我们研究了99例X综合征患者（78例女性，21例男性；平均年龄±标准差48.5±8岁）。所有患者均接受了临床特征描述、动态心电图监测以及随访7±4年期间的左心室功能超声心动图评估。
该综合征在女性中比男性更常见。在女性患者中，61.5%在胸痛发作前已绝经。所有99例患者均有劳力性心绞痛，41例还伴有静息性心绞痛。53%的患者胸痛发作的平均持续时间>10分钟。42%的患者舌下含服硝酸酯类药物能有效缓解疼痛。动态心电图监测期间，64例患者出现短暂性ST段压低，22例出现心肌灌注异常。在运动试验的第一阶段，32例患者收缩压升高>20mmHg，且与收缩压升高≤20%的患者相比，ST段压低出现更早、运动时间更短。随访期间，无死亡或心肌梗死发生，心室功能无变化（缩短分数35.4±4%对35.6±3%；仅1例患者发生心力衰竭），8例患者出现系统性高血压，4例出现传导障碍。11例患者症状减轻，64例症状多变或无变化，24例症状加重。
本研究中定义的X综合征主要发生在绝经后女性。患者通常有典型的心绞痛胸痛，但传统的抗心绞痛治疗往往不成功。一小部分患者出现心肌灌注异常。长期生存未受到不利影响，心脏功能恶化很少发生。
