Further Peripheral Vascular Dysfunction in Heart Failure Patients With a Continuous-Flow Left Ventricular Assist Device: The Role of Pulsatility.
Further Peripheral Vascular Dysfunction in Heart Failure Patients With a Continuous-Flow Left Ventricular Assist Device: The Role of Pulsatility.
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DOI：
10.1016/j.jchf.2015.04.012
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发表时间：
2015-09
期刊：
影响因子：
--
通讯作者：
Richardson RS
中科院分区：
文献类型：
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作者：
Witman MA;Garten RS;Gifford JR;Groot HJ;Trinity JD;Stehlik J;Nativi JN;Selzman CH;Drakos SG;Richardson RS
射血分数降低（HFrEF）心力衰竭患者的外周内皮功能被认为受损，但目前作为移植桥接或目的地治疗的连续流左心室辅助装置（LVAD）植入术的外周血管效应仍不清楚。使用血流介导的血管舒张（FMD）和反应性充血（RH），本研究旨在更深入地了解LVAD诱导的外周血管功能变化。68名受试者（13名纽约心脏协会（NYHA）II级HFrEF患者，19名NYHA III/IV级HFrEF患者，20名LVAD植入后NYHA III/IV级HFrEF患者，以及16名健康年龄匹配的对照者）接受了肱动脉FMD和RH测试，并通过超声多普勒评估了血流速度、动脉直径和脉动指数（PI）。LVAD组的PI（2.0 ± 0.4）显著低于HFrEF II（8.6 ± 0.8）和HFrEF III/IV（8.1 ± 0.9）患者，后者显著低于对照组（12.8 ± 0.9）。同样，LVAD %FMD/切变率（0.09 ± 0.01% Δ/s−1）与所有其他组（对照组，0.24 ± 0.03; HFrEF II，0.17 ± 0.02和HFrEF III/IV，0.13 ± 0.02% Δ/s−1）相比显著降低，%FMD/切变率与PI显著相关（r=0.45）。各组的RH均不显著。尽管HFrEF患者的中心血流动力学通过连续流LVAD得到改善，但外周血管功能进一步受损，这可能至少部分是由于脉动性降低，而脉动性是这种机械辅助装置的特征。
Peripheral endothelial function is recognized to be impaired in patients with heart failure with reduced ejection fraction (HFrEF), but the peripheral vascular effects of continuous-flow left ventricular assist device (LVAD) implantation, now employed as either a bridge-to-transplantation or as a destination therapy, remain unclear. Using flow-mediated vasodilation (FMD) and reactive hyperemia (RH), this study aimed to provide greater insight into LVAD-induced changes in peripheral vascular function. Sixty-eight subjects (13 New York Heart Association (NYHA) Class II HFrEF patients, 19 NYHA Class III/IV HFrEF patients, 20 NYHA Class III/IV HFrEF patients post-LVAD implantation, and 16 healthy age-matched controls) underwent FMD and RH testing in the brachial artery with blood flow velocity, artery diameters, and pulsatility index (PI) assessed by ultrasound Doppler. PI was significantly lower in the LVAD group (2.0 ± 0.4) compared to both the HFrEF II, (8.6 ± 0.8) and HFrEF III/IV (8.1 ± 0.9) patients, who, in turn, were significantly lower than the controls (12.8 ± 0.9). Likewise, LVAD %FMD/shear rate (0.09 ± 0.01 %Δ/s−1) was significantly reduced compared to all other groups (controls, 0.24 ± 0.03; HFrEF II, 0.17 ± 0.02 and HFrEF III/IV, 0.13 ± 0.02 %Δ/s−1) and %FMD/shear rate was significantly correlated with PI (r=0.45). RH was unremarkable across groups. Although central hemodynamics are improved in patients with HFrEF by a continuous-flow LVAD, peripheral vascular function is further compromised, likely due, at least in part, to the reduction in pulsatility that is a characteristic of such a mechanical assist device.