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严重主动脉瓣疾病患者心绞痛的临床、血流动力学及冠状动脉造影相关性

Clinical, haemodynamic, and coronary angiographic correlates of angina pectoris in patients with severe aortic valve disease.

作者信息

Basta L L, Raines D, Najjar S, Kioschos J M

出版信息

Br Heart J. 1975 Feb;37(2):150-7. doi: 10.1136/hrt.37.2.150.

Abstract

Of 88 consecutive patients aged 20 to 77 years with severe symptomatic aortic valve disease requiring surgery, 51 patients had angina pectoris; of these 51, 41 had predominant aortic stenosis and 10 had severe aortic regurgitation. All patients with angina pectoris underwent coronary angiography; significant coronary arterial disease was encounted in 24 per cent of those with aortic stenosis and 20 per cent of those with aortic regurgitation. By contrast, of 37 patients without angina pectoris 19 underwent coronary arteriography; none showed significant coronary artery disease (P smaller than 0.05). Among patients with angina pectoris, 17 per cent of those with aortic stenosis experienced prolonged, rest or nocturnal pain, compared to 70 per cent of those with aortic regurgitation (P smaller than 0.005). At the time of onset of angina pectoris, there were features of heart failure in 34 per cent of those with aortic stenosis, and in 90 per cent of those with aortic regurgitation (P smaller than 0.005). Nitroglycerin promptly relieved angina pectoris in 56 percent of patients with aortic stenosis and in 50 per cent of those with aortic regurgitation (P smaller than 0.05). Neither the pattern of angina pectoris nor the response to nitroglycerin was dependent upon the coexistence of significant coronary artery disease. In patients with aortic stenosis, there was not significant difference between those with angina pectoris, and those without angina with regard to left ventricular end-diastolic volume, end-diastolic pressure, ejection fraction, peak systolic pressure, wall thickness, cardiac index, or the product of these factors. In patients with aortic regurgitation, cardiac index was significantly lower (P smaller than 0.05), left ventricular end-diastolic volume tended to be larger, and ejection fraction tended to be lower in patients with angina pectoris as opposed to those without angina pectoris.

摘要

在88例年龄在20至77岁之间、患有严重症状性主动脉瓣疾病且需要手术治疗的连续患者中,51例患有心绞痛;在这51例患者中,41例以主动脉瓣狭窄为主,10例患有严重主动脉瓣反流。所有心绞痛患者均接受了冠状动脉造影;主动脉瓣狭窄患者中有24%发现有显著冠状动脉疾病,主动脉瓣反流患者中有20%发现有显著冠状动脉疾病。相比之下,在37例无心绞痛的患者中,19例接受了冠状动脉造影;无一例显示有显著冠状动脉疾病(P小于0.05)。在心绞痛患者中,主动脉瓣狭窄患者中有17%经历过持续性、静息性或夜间疼痛,而主动脉瓣反流患者中有70%经历过此类疼痛(P小于0.005)。在心绞痛发作时,主动脉瓣狭窄患者中有34%有心力衰竭特征,主动脉瓣反流患者中有90%有心力衰竭特征(P小于0.005)。硝酸甘油能迅速缓解56%的主动脉瓣狭窄患者和50%的主动脉瓣反流患者的心绞痛(P小于0.05)。心绞痛模式和对硝酸甘油的反应均不取决于显著冠状动脉疾病的共存情况。在主动脉瓣狭窄患者中,有心绞痛患者与无心绞痛患者在左心室舒张末期容积、舒张末期压力、射血分数、收缩压峰值、壁厚、心脏指数或这些因素的乘积方面无显著差异。在主动脉瓣反流患者中,与无心绞痛患者相比,心绞痛患者的心脏指数显著较低(P小于0.05),左心室舒张末期容积往往较大,射血分数往往较低。

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