Bionic women and men - Part 4: Cardiovascular, cerebrovascular and exercise responses among patients supported with left ventricular assist devices.
Bionic women and men - Part 4: Cardiovascular, cerebrovascular and exercise responses among patients supported with left ventricular assist devices.
复制标题
仿生女性和男性 - 第 4 部分：左心室辅助装置支持的患者的心血管、脑血管和运动反应。
DOI：
10.1113/ep088325
复制
发表时间：
2020
影响因子：
2.7
通讯作者：
Cornwell3rd,WilliamK
中科院分区：
文献类型：
--
作者：
Buchanan,Cullen;Kanwar,Manreet;Cockcroft,JohnR;McDonnell,Barry;Stöhr,EricJ;Cornwell3rd,WilliamK
新发现LVAD患者易患高血压，这可能增加中风的风险。高血压可能是由于交感神经活动水平显著升高所致。交感神经活动是通过压力感受器介导的通路对长期暴露于非生理性（和降低的）脉冲做出反应而发生的。在没有生理性脉冲的情况下，大脑自动调节过程似乎得以保留。然而，缺血性/栓塞性和出血性卒中的发生率高得令人无法接受，并且是这些患者发病率和死亡率的主要原因。尽管静息心输出量正常化，LVAD患者仍遭受持续的、严重的功能能力降低。用于治疗晚期心力衰竭患者。然而，LVAD的使用有许多副作用，包括高血压、胃肠道出血、中风以及尽管静息心输出量正常化但功能能力持续严重受限。这些问题在很大程度上与长期暴露于非生理性脉冲有关，这有助于肾上腺素能环境，其特征在于通过压力感受器介导的通路交感神经活动水平显著升高。此外，这些机器无法参与或促成试图调节通过身体的流量的正常心血管/自主神经反射。推进器械技术和开发生物敏感器械的努力可能会解决这些问题，并进一步改善其支持的患者的生活质量、功能能力，并最终改善其生存率。
New FindingsLVAD patients are predisposed to hypertension which may increase the risk of stroke. Hypertension may result from markedly elevated levels of sympathetic nerve activity, which occurs through a baroreceptor‐mediated pathway in response to chronic exposure to a non‐physiologic (and reduced) pulse.Cerebral autoregulatory processes appear to be preserved in the absence of a physiologic pulse. Nevertheless, the rate of ischemic/embolic and hemorrhagic stroke is unacceptably high and is a major cause of morbidity and mortality in these patients.Despite normalization of a resting cardiac output, LVAD patients suffer from persistent, severe reductions in functional capacity.AbstractCurrent generation left ventricular assist devices (LVADs) have led to significant improvements in survival compared to medical therapy alone, when used for management of patients with advanced heart failure. However, there are a number of side‐effects associated with LVAD use, including hypertension, gastrointestinal bleeding, stroke, as well as persistent and severe limitations in functional capacity despite normalization of a resting cardiac output. These issues are, in large part, related to chronic exposure to a non‐physiologic pulse, which contributes to a hyperadrenergic environment characterized by markedly elevated levels of sympathetic nerve activity through a baroreceptor‐mediated pathway. In addition, these machines are unable to participate in, or contribute to, normal cardiovascular/autonomic reflexes that attempt to modulate flow through the body. Efforts to advance device technology and develop biologically sensitive devices may resolve these issues, and lead to further improvements in quality‐of‐life, functional capacity, and ultimately, survival, for the patients they support.