Dargie H J
CRI in Heart Failure, University of Glasgow, U.K.
Eur Heart J. 1996 Dec;17 Suppl G:2-7. doi: 10.1093/eurheartj/17.suppl_g.2.
Angina with left ventricular dysfunction exhibits a wide range of different presentations. Approximately 45% of patients referred for coronary artery bypass surgery have some degree of left ventricular dysfunction and, given that at least a third of those suffering from angina have a history of myocardial infarction, the prevalence of left ventricular dysfunction in such patients is likely to be substantial. The major prognostic factor in patients with coronary artery disease is the degree of left ventricular function and it is important to identify those with poor or reduced left ventricular function. High-risk patients, defined by exercise testing and echocardiography, should be considered for revascularization. For the majority of patients management should be medical, consisting of nitrates plus a beta-blocker or calcium antagonist. In severe ischaemia, the combination of these agents has been shown to provide additional efficacy. In patients with heart failure the newer calcium antagonist amlodipine has been shown to have a neutral effect upon survival, indicating that it may be used safely in patients with angina and left ventricular dysfunction. Progression of left ventricular dysfunction may be slowed through the use of angiotensin converting enzyme (ACE) inhibitors, which have also been shown to improve survival, although they should be used with caution, since there is evidence that ACE inhibitors may worsen angina in some patients.
伴有左心室功能不全的心绞痛表现出广泛的不同症状。在接受冠状动脉搭桥手术的患者中，约45%存在一定程度的左心室功能不全，而且鉴于至少三分之一的心绞痛患者有心肌梗死病史，此类患者中左心室功能不全的患病率可能相当高。冠状动脉疾病患者的主要预后因素是左心室功能的程度，识别左心室功能差或减退的患者很重要。通过运动试验和超声心动图定义的高危患者应考虑进行血运重建。对于大多数患者，治疗应以药物为主，包括硝酸酯类药物加β受体阻滞剂或钙拮抗剂。在严重缺血时，这些药物联合使用已显示出额外的疗效。在心力衰竭患者中，新型钙拮抗剂氨氯地平已被证明对生存率无影响，这表明它可安全用于心绞痛和左心室功能不全患者。使用血管紧张素转换酶（ACE）抑制剂可能会减缓左心室功能不全的进展，并且也已证明其可提高生存率，不过应谨慎使用，因为有证据表明ACE抑制剂可能会使某些患者的心绞痛恶化。
