Paquay P A, Anderson G, Diefenthal H, Nordstrom L, Richman H G, Gobel F L
Am J Cardiol. 1976 Dec;38(7):863-9. doi: 10.1016/0002-9149(76)90799-2.
To clarify the association between chest pain and significant coronary artery disease in patients who have aortic valve disease, 76 consecutive candidates for aortic valve replacement were evaluated prospectively with use of a historical questionnaire and coronary arteriography. Of the 76 patients, 19 (25 percent) had no chest pain, 21 (28 percent) had chest pain that was not typical of angina pectoris and 36 (47 percent) had chest pain typical of anigina pectoris. In 18 of 19 patients the absence of chest pain correlated with the absence of coronary artery disease. The single patient without chest pain who had coronary artery disease had evidence of an inferior myocardial infarction in the electrocardiogram. Thus, absence of chest pain and the absence of electrocardiographic evidence of infarction predicted the absence of coronary disease in all cases. The presence of chest pain did not predict the presence of coronary artery disease, but the more typical the pain of angina pectoris the more likely were patients to have significant coronary artery disease. Of the 21 patients with atypical chest pain, 6 (29 percent) had coronary artery disease, but of the 36 patients with typical angina pectoris 23 (64 percent) had significant coronary artery disease. In addition, when patients with chest pain not typical of angina pectoris also had coronary artery disease, the diseased vessels usually supplied smaller areas of the left ventricle than when the pain was typical of angina pectoris. In 21 of 23 patients (91 percent) with typical angina pectoris and significant coronary artery disease, lesions were present in the left coronary artery. There was no systolic pressure gradient across the aortic valve that excluded the presence of coronary artery disease, although all patients with a calculated aortic valve area of less than 0.4 cm2 were free of coronary artery disease. Patients with severe left ventricular dysfunction were more likely to have normal coronary arteries.
为明确主动脉瓣疾病患者胸痛与严重冠状动脉疾病之间的关联，我们前瞻性地对76例连续的主动脉瓣置换术候选患者进行了评估，采用了一份既往问卷和冠状动脉造影。在这76例患者中，19例（25%）无胸痛，21例（28%）有非典型心绞痛的胸痛，36例（47%）有典型心绞痛的胸痛。在19例无胸痛的患者中，18例无胸痛与无冠状动脉疾病相关。唯一一例无胸痛但有冠状动脉疾病的患者心电图有下壁心肌梗死的证据。因此，无胸痛且无心电图梗死证据在所有病例中均预示无冠状动脉疾病。胸痛的存在并不能预示冠状动脉疾病的存在，但心绞痛疼痛越典型，患者患有严重冠状动脉疾病的可能性就越大。在21例有非典型胸痛的患者中，6例（29%）有冠状动脉疾病，但在36例有典型心绞痛的患者中，23例（64%）有严重冠状动脉疾病。此外，当有非典型心绞痛胸痛的患者也有冠状动脉疾病时，与疼痛为典型心绞痛时相比，病变血管通常供应左心室的面积较小。在23例有典型心绞痛且有严重冠状动脉疾病的患者中，21例（91%）左冠状动脉有病变。尽管所有计算出的主动脉瓣面积小于0.4 cm²的患者均无冠状动脉疾病，但没有主动脉瓣跨瓣收缩压差可排除冠状动脉疾病的存在。严重左心室功能不全的患者更有可能有正常冠状动脉。
