Archer S L, Mike D K, Hetland M B, Kostamo K L, Shafer R B, Chesler E
Veterans Administration Medical Center, Minneapolis, Minnesota 55417.
Am J Cardiol. 1994 Feb 1;73(4):275-81. doi: 10.1016/0002-9149(94)90233-x.
Consecutive, symptomatic (n = 15) and asymptomatic (n = 25) men with aortic stenosis (valve area < 1.2 cm2) and no clinical evidence of myocardial ischemia underwent radionuclide angiography at rest and during supine bicycle ergometry. Ejection fraction, diastolic filling pattern and aortic valve area/gradient were measured on enrollment and when patients became symptomatic (n = 10) or underwent valve replacement (n = 22) during a 2-year follow-up period. Both groups had similar heart rate, blood pressure and ejection fractions, but mean aortic gradients were higher in symptomatic (53 +/- 4 mm Hg) than asymptomatic (37 +/- 2 mm Hg) subjects p < 0.01. Functional limitation evoked by exercise was prevalent even in the asymptomatic group but symptomatic patients exercised to lower work levels than asymptomatic subjects (184 +/- 27 and 307 +/- 32 kg.m/min, respectively, p = 0.02). Ejection fraction failed to increase with exercise in either group. Symptomatic subjects had supranormalization of early diastolic filling with shorter time to the peak filling rate than asymptomatic subjects (137 +/- 16 and 172 +/- 9 ms, respectively, p < 0.05) and a greater first 1/3 filling fraction. The 10 patients who became symptomatic during follow-up had higher first 1/3 filling fractions (53 +/- 7 and 42 +/- 5%, respectively) and mean gradients (41 +/- 4 and 33 +/- 2 mm Hg, respectively) than subjects who remained asymptomatic, p < 0.05. High mean aortic gradients, impaired exercise tolerance and enhanced early diastolic filling distinguish symptomatic from asymptomatic patients.
连续纳入15例有症状和25例无症状的主动脉瓣狭窄男性患者（瓣膜面积<1.2 cm²），且无心肌缺血的临床证据，对其进行静息和仰卧位踏车运动时的放射性核素血管造影。在入组时以及患者在2年随访期内出现症状（n = 10）或接受瓣膜置换（n = 22）时，测量射血分数、舒张期充盈模式以及主动脉瓣面积/压力阶差。两组患者的心率、血压和射血分数相似，但有症状患者的平均主动脉压力阶差（53±4 mmHg）高于无症状患者（37±2 mmHg），p<0.01。即使在无症状组，运动诱发的功能受限也很普遍，但有症状患者的运动负荷低于无症状患者（分别为184±27和307±32 kg·m/min，p = 0.02）。两组患者运动时射血分数均未增加。有症状患者早期舒张期充盈超正常化，达到峰值充盈率的时间短于无症状患者（分别为137±16和172±9 ms，p<0.05），且前1/3充盈分数更大。随访期间出现症状的10例患者的前1/3充盈分数（分别为53±7%和42±5%）和平均压力阶差（分别为41±4和33±2 mmHg）高于无症状患者，p<0.05。高平均主动脉压力阶差、运动耐量受损和早期舒张期充盈增强可区分有症状和无症状患者。
