Ventricular-Arterial Coupling Derived From Proximal Aortic Stiffness and Aerobic Capacity Across the Heart Failure Spectrum
Ventricular-Arterial Coupling Derived From Proximal Aortic Stiffness and Aerobic Capacity Across the Heart Failure Spectrum
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DOI：
10.1016/j.jcmg.2022.03.024
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发表时间：
2022-09-01
影响因子：
14
通讯作者：
Masi, Stefano
中科院分区：
文献类型：
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作者：
Pugliese, Nicola Riccardo;Balletti, Alessio;Masi, Stefano
背景 心室动脉耦合 (VAC) 可以用动脉硬度（脉冲波速度 [PWV]）与心肌变形（整体纵向应变 [GLS]）之间的比率来评估。 目的 本研究旨在评估整个心力衰竭 (HF) 范围内的 VAC。 方法 除了基于张力测量的方法之外，作者还引入了一种基于多普勒的单次心跳技术来估计主动脉弓 PWV (aa-PWV)。颈动脉-股动脉 PWV (cf-PWV)。他们测量了 155 名健康对照者、75 名有发生 HF 风险的受试者（美国心脏病学会/美国心脏协会 A-B 期）和 236 名射血分数保留的心力衰竭 (HFpEF) (n = 104) 或射血分数降低的心力衰竭 (HFrEF) (n = 132) 的 C 期患者的 PWV5 和 GLS。他们使用心肺超声心动图联合运动应激评估了峰值耗氧量和外周抽血量。结果所有受试者均可获得 as-PWV，并且所有亚组均显着低于 cf-PWV（P < 0.01）。 PWV 直接相关并随着年龄的增长而增加（所有 P < 0.0001）。 cf-PWV/GLS 在 HFrEF (1.09 +/- 0.35) 和 HFpEF (1.05 +/- 0.21) 中同样受到损害，而 aa-PWV/GLS 在 HFpEF (0.70 +/- 0.10) 中比 HFrEF (0.61 +/- 0.14; P < 0.01) 中受损更严重。 A-B 阶段的 cf-PWV/GLS 和 aa-PWV/GLS 值（分别为 0.67 L 0.27 和 0.48 1 0.14）高于对照组（分别为 0.46 +/- 0.11 和 0.39 +/- 0.10），但低于 C 阶段（均 P < 0.01）。峰值动静脉氧差 (AVO(2) diff) 与 cf-PWV/GLS 和 aa-PWV/GLS 呈负相关 (P < 0.01)。尽管 cf-PWV/GLS 和 aa-PWV/GLS 独立预测总体人群中的峰值摄氧量（调整后的 R-2 = 0.33 和 R-2 = 0.36；alt P < 0.0001），但只有 aa-PWV/GLS 与运动期间的血流储备独立相关（R-2 = 0.52；P < 0.0001）。 结论 VAC 异常直接与血流储备相关。与更严重的心力衰竭和更差的功能能力相关。当用 aa-PWV/GLS 表示时，HFpEF 显示出比 HFrEF 更差的 VAC。 (C) 2022 年，美国心脏病学会基金会。
BACKGROUND Ventricular-arterial coupling (VAC) can be evaluated as the ratio between arterial stiffness (pulsed wave velocity [PWV]) and myocardial deformation (global longitudinal strain [GLS]).OBJECTIVES This study aimed to evaluate VAC across the spectrum of heart failure (HF).METHODS The authors introduced a Doppler-derived, single-beat technique to estimate aortic arch PWV (aa-PWV) in addition to tonometry-derived carotid-femoral PWV (cf-PWV). They measured PWV5 and GLS in 155 healthy controls, 75 subjects at risk of developing HF (American College of Cardiology/American Heart Association stage A-B) and 236 patients in stage C heart failure with preserved ejection fraction (HFpEF) (n = 104) or heart failure with reduced ejection fraction (HFrEF) (n = 132). They evaluated peak oxygen consumption and peripheral extraction using combined cardiopulmonary-echocardiography exercise stress.RESULTS as-PWV was obtainable in all subjects and significantly lower than cf-PWV in all subgroups (P < 0.01). PWVs were directly related and increased with age (all P < 0.0001). cf-PWV/GLS was similarly compromised in HFrEF (1.09 +/- 0.35) and HFpEF (1.05 +/- 0.21), whereas aa-PWV/GLS was more impaired in HFpEF (0.70 +/- 0.10) than HFrEF (0.61 +/- 0.14; P < 0.01). Stage A-B had values of cf-PWV/GLS and aa-PWV/GLS (0.67 L 0.27 and 0.48 1 0.14, respectively) higher than controls (0.46 +/- 0.11 and 0.39 +/- 0.10, respectively) but lower than stage C (all P < 0.01). Peak arteriovenous oxygen difference (AVO(2) diff) was inversely related with cf-PWV/GLS and aa-PWV/GLS P < 0.01). Although cf-PWV/GLS and aa-PWV/GLS independently predicted peak VO2 in the overall population (adjusted R-2 = 0.33 and R-2 = 0.36; alt P < 0.0001), only aa-PWV/GLS was independently associated with flow reserve during exercise (R-2 = 0.52; P < 0.0001).CONCLUSIONS Abnormal VAC is directly correlated with greater severity of HF and worse functional capacity. HFpEF shows a worse VAC than HFrEF when expressed by aa-PWV/GLS. (C) 2022 by the American College of Cardiology Foundation.