| Objective: Based on clinical data of Chinese, the article, using stable angina pectoris (SAP) as contrast, is to study the clinical characteristics and its pathogenesis of walk-through angina (WTA) and by which clinicians have a comprehensive knowledge for this rare type of angina. People can lower the possibility of missed diagnosis and misdiagnosis the disease as much as possible and to provide reliable theoretical support for clinical intervention to WTA.Method:The patients who have been selected for the study are cardiovascular medical inpatients from November 2005 to February 2008 in our hospital, and all of them were diagnosed with coronary artery disease, exactly speaking, all patients had clinical symptoms of angina pectoris, and coronary angiography showed that stenosis of at least one branch coronary artery was more than 50% and the left main lesion was ruled out. 28 cases patients with WTA and 28 cases SAP respectively were selected to the study. The diagnostic criteria of WTA is that the patients feel angina pectoris attacks with initial activities. But as the activity continues, the degree of angina was not increase, it gradually reduced or even disappeared instead. Exercise tests showed that exercise could induce angina attacks at the same time ECG indicated that ST segment depression was more 1mm and with the activity continues, the degree of angina relieved even the symptom of angina disappeared and ECG indicated myocardial ischemia recovered completely. On the other hand, the diagnostic criteria of SAP was that the patients felt that labour can induced angina attacks and rest could relieve angina symptom rapidly and patient condition were stable for two months. The two groups were performed routine examination and treatment. After asking their disease history, their attitudes to the disease and doctor-seeing history, we summarized both patient's attitude and doctor's knowledge about the disease. At the same time, we observed the risk factors of coronary heart disease, clinical features, ECG performance, the results of heart ultrasound, the results of coronary angiography, treadmill exercise testing, and the ability of heart rate response in the two groups with coronary heart disease. The index of heart ultrasound included anteroposterior diameter of right antrum (RAD), anteroposterior diameter of right ventricle (RVD), anteroposterior diameter of left antrum (LAD), anteroposterior diameter of left ventricle in end-diastole (LVEDd), anteroposterior diameter of left ventricle in end-systole (LVEDs), ejection fraction of left ventricle (LVEF), shortening fraction of left ventricle (LVFS), E peak, A peak and E/A ratio. According to the results of coronary angiography, coronary artery disease lesions were divided into single- vessel disease, double-vessel disease, and three-vessel disease and, and coronary arteries stenosis was divided into mild coronary stenosis of 50-74%, moderate stenosis of 75-89%, severe stenosis above 90% and complete occlusion of 100% and coronary artery disease type was divided into A type lesion, B type lesion and C type lesion. The indexes of treadmill exercise testing were mainly exercise test ST-segment depression in timing, duration, magnitude and the number of leads and change of the ability of heart rate response between the two groups. The positive index of heart rate response disability were that the maximal heart rate (Max HR) in movement didn't reach the predicted maximal heart rate of eighty-five percent (220-age) and that chronotropic response index was less than zero point eight. We used the way of Grouped t-test to compare the average between the two groups, chi-square test to compare the categorical data, respectively. P<0.05 has the difference in the meaning of statistics.Results: According to the asking history, patients suffering from WTA paid no attention to the importance to the disease. Before the diagnosis of WTA,they have been at least more than once misdiagnosed or missed diagnose in a hospital, and the rate of misdiagnosis and/or missed diagnosis was one hundred percent. Judging from the clinical manifestations, the symptoms of WTA patients were quite different from those suffering from SAP. The WTA patients felt typical angina pectoris with initial activities. But as the activity continues, angina did not show increase, it gradually reduced or even disappeared instead. The clinical manifestation of SAP was that the patients felt that labour could induce angina attacks and rest could relieve angina symptom rapidly. The results of WTA group and SAP group heart ultrasound were as follows: RAD were 19.52±1.54 mm and 18.56±1.61 mm , P>0.05 ; RVD were 17.68±1.43 mm and 19.03±1.36 mm , P>0.05 ; LAD were 33.66±7.12 mm and 30.21±6.21 mm , P>0.05 ; LVEDd were 56.17±9.70 mm and 44.21±7.31 mm , P<0.01 ; LVEDs were 48.28±6.67 mm and 37.61±4.11 mm , P<0.01 ; LVEF were 48.22±6.53 % and 62.37±9.77 % , P<0.01 ; LVFS were 23.92±3.13 % and 30.92±4.64 % , P<0.01 ; E peak were 0.58±0.12 m/s and 0.66±0.17 m/s , P>0.05 ; A peak were 0.83±0.19 m/s and 0.74±0.14 m/s , P>0.05 and E/A ratio was less than 1, respectively. The results of WTA group and SAP group coronary angiography indicated that single-vessel lesions were 5 (17.86%) and 13 (46.43%) cases, P<0.05; Double -vessel group were 8 (28.57%) and 10 (35.71%) cases, P >0.05 and three lesions were 15 (53.57%) and 5 (17.86%) cases, P <0.01and the grade of coronary artery stenosis was that light stenosis were 0(0.00%) and 6(21.43%) cases,P <0.05; Moderate stenosis were 0 (0.00%) and 10 (35.71%) cases,P <0.01;Severe stenosis were 8 (28.57%) and 8 (28.57%) cases, P >0.05; Total occlusion were 20(71.43%)and 4(14.29%)cases, P <0.01and the type of coronary artery was that type A were 0(0.00%) and 11(39.29%)cases,P <0.01;Type B were 8(28.57%) and 13(46.43%) cases,P >0.05;Type C were 20(71.43%) and 4 (14.29%)cases, P <0.01 and collateral circulation of coronary artery were 28(100%)and 4(14.29%)cases, P <0.01, respectively. The results of WTA group and SAP group readmill test indicated that ST-segment depression in time was 512.43±46.49S and 591.03±5.27S P<0.01; ST segment depression in the lead number was 3.01±0.51 and 6.10±0.76, P<0.01;CRI was 0.48±0.05 and 0.74±0.07, P<0.01;Maximal heart rate in movement was 124.32±6.89 beat /min and 145.35±5.25 beat/min P<0.01; The metabolic cost of maximum exercise was 5.64±0.62 Mets and 4.87±0.48 Mets,P<0.01 in the WTA group and SAP group, respectively. The patients in the two groups were all discharged.Conclusion: We are the first to systemic study and report a rare special type of angina-WTA. The clinical characteristics is not type of angina in Chinese and the clinical symptom is relative light. Labour can induce angina pectoris attacks. But as the activity continues, the degree of angina is not increase, it gradually reduces or even disappeares instead. Doctors and patients pays no attention to the disease. So, this type of angina is easily missed diagnosis and misdiagnosis by clinicians. However, the excise test shows that patients with WTA are severer in myocardial ischemia and worse in the ability of heart rate response and the results of CAG are severe and widespread lesions and always two or three branch lesions in coronary arteries as well as there are obvious collateral circulation in patients with WTA. Obvious collateral circulation is one of the pathogenesis in the patients with WTA. Revascularization is reasonable interventional select for the patients with WTA. |
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