Kaufmann P, Mandinov L, Frielingsdorf J, Hess O M
Department of Cardiology, University Hospital, Zurich, Switzerland.
Coron Artery Dis. 1998;9(4):185-90. doi: 10.1097/00019501-199809040-00003.
Clinical symptoms have been found to correlate only poorly with the severity of the culprit lesion in coronary artery disease. The purpose of the present study was to evaluate the influence of the culprit lesion and its change during exercise on clinical symptoms in patients with this condition.
Minimal luminal area was determined using biplane quantitative coronary angiography in 42 patients (aged 53 +/- 8 years) with coronary artery disease. Percent diameter stenosis and minimal luminal area and its change during exercise were assessed in all patients and compared with clinical symptoms judged according to the functional classification of the New York Heart Association (NYHA). Coronary dimensions were determined with the patient at rest, during supine bicycle exercise and after sublingual administration of 1.6 mg glyceryl trinitrate.
Exercise-induced vasoconstriction of the culprit lesion was found in all patients (-14.0% at 102 W), but there was exercise-induced vasodilatation in the normal vessel segments (+13.0%). However, only minimal vasoconstriction was found in groups 1 (NYHA I: -0.5%, NS) and 2 (NYHA II: -4.7%, NS), but significant constriction in groups 3 (NYHA II-III: -18.0%, P < 0.01) and 4 (NYHA III: -31.4, P < 0.01). Vasodilatation of the normal vessel segments was similar in the four groups. The observed inverse relationship between exercise-induced changes in minimal luminal area and NYHA classification was stronger than the relationship between NYHA and minimal luminal area when the patient was at rest. There was no correlation between glyceryl trinitrate-induced vasodilatation and NYHA classification.
The more severe the culprit lesion, the more pronounced the exercise-induced vasoconstriction. This effect of the culprit lesion was reflected by the clinical symptoms: the greater the exercise-induced vasoconstriction, the higher the NYHA classification. Thus the anatomy of the lesion (= severity) and the functional integrity of the endothelium (= exercise-induced vasomotion) are two major determinants of clinical symptoms.
临床症状已被发现与冠心病罪犯病变的严重程度仅有微弱的相关性。本研究的目的是评估罪犯病变及其在运动过程中的变化对患有这种疾病患者临床症状的影响。
使用双平面定量冠状动脉造影术测定了42例（年龄53±8岁）冠心病患者的最小管腔面积。评估了所有患者的直径狭窄百分比、最小管腔面积及其在运动过程中的变化，并与根据纽约心脏协会（NYHA）功能分级判断的临床症状进行比较。在患者静息时、仰卧位自行车运动期间以及舌下含服1.6毫克硝酸甘油后测定冠状动脉尺寸。
所有患者均发现运动诱导的罪犯病变血管收缩（在102瓦时为-14.0%），但正常血管段存在运动诱导的血管扩张（+13.0%）。然而，在1组（NYHA I：-0.5%，无统计学意义）和2组（NYHA II：-4.7%，无统计学意义）中仅发现最小程度的血管收缩，但在3组（NYHA II-III：-18.0%，P<0.01）和4组（NYHA III：-31.4，P<0.01）中有显著收缩。正常血管段的血管扩张在四组中相似。观察到的运动诱导的最小管腔面积变化与NYHA分级之间的负相关关系比患者静息时NYHA与最小管腔面积之间的关系更强。硝酸甘油诱导的血管扩张与NYHA分级之间无相关性。
罪犯病变越严重，运动诱导的血管收缩越明显。罪犯病变的这种效应通过临床症状得以体现：运动诱导的血管收缩越大，NYHA分级越高。因此，病变的解剖结构（=严重程度）和内皮的功能完整性（=运动诱导的血管运动）是临床症状的两个主要决定因素。
