Arterial stiffness and wave reflection: sex differences and relationship with left ventricular diastolic function.
Arterial stiffness and wave reflection: sex differences and relationship with left ventricular diastolic function.
复制标题
DOI：
10.1161/hypertensionaha.112.191148
复制
发表时间：
2012-08
期刊：
影响因子：
--
通讯作者：
Di Tullio MR
中科院分区：
文献类型：
--
作者：
Russo C;Jin Z;Palmieri V;Homma S;Rundek T;Elkind MS;Sacco RL;Di Tullio MR
据报道，射血分数(HFNEF)正常的心力衰竭患者和无症状左心室(LV)舒张期功能不全患者(HFNEF的先兆)，动脉僵硬和波形反射增加。目前尚不清楚HFNEF频率较高的女性是否比男性更容易受到动脉僵硬对左室舒张功能的有害影响。我们在一个以社区为基础的大型队列中调查了动脉僵硬、波反射和左心舒张功能之间的关系是否存在性别差异。使用压平眼压计对983名心血管异常和脑损伤(CABL)研究的参与者进行了动脉僵硬和波形反射的评估。以中心脉压/每搏输出量指数(CPP/SVI)、总动脉顺应性、脉压放大和增大指数作为动脉僵硬和反射波的参数。应用二维超声心动图和组织多普勒超声心动图评价左室舒张功能。与男性相比，女性的动脉僵硬和波形反射更大，与身体大小和心率无关(均P<；0.01)，并且在男女中与舒张期功能参数呈负相关。心血管危险因素的进一步调整减弱了这些关系；然而，较高的CPP/SVI预测女性[优势比(OR)1.54，95%可信区间(CI)1.03-2.30]和男性(OR：2.09，95%CI 1.30-3.39)的左室舒张功能障碍，而不受其他危险因素的影响。总而言之，在我们基于社区的队列研究中，男性和女性的动脉僵硬程度越高，左室舒张功能越差。女性较高的动脉僵硬与身体大小无关，可能是导致她们更容易发生HFNEF的原因之一。
Increased arterial stiffness and wave reflection have been reported in heart failure with normal ejection fraction (HFNEF) and in asymptomatic left ventricular (LV) diastolic dysfunction, a precursor of HFNEF. It is unclear whether women, who have higher frequency of HFNEF, are more vulnerable than men to the deleterious effects of arterial stiffness on LV diastolic function. We investigated in a large community-based cohort, whether sex differences exist in the relationship between arterial stiffness, wave reflection and LV diastolic function. Arterial stiffness and wave reflection were assessed in 983 participants from the Cardiovascular Abnormalities and Brain Lesions (CABL) study using applanation tonometry. Central pulse pressure/stroke volume index (cPP/SVi), total arterial compliance, pulse pressure amplification and augmentation index were used as parameters of arterial stiffness and wave reflection. LV diastolic function was evaluated by two-dimensional echocardiography and tissue-Doppler imaging. Arterial stiffness and wave reflection were greater in women compared to men, independent of body size and heart rate (all p<0.01), and showed inverse relationships with parameters of diastolic function in both sexes. Further adjustment for cardiovascular risk factors attenuated these relationships; however, higher cPP/SVi predicted LV diastolic dysfunction in women [odds ratio (OR) 1.54, 95% confidence intervals (CI) 1.03–2.30] and men (OR: 2.09, 95% CI 1.30–3.39) independent of other risk factors. In conclusion, in our community-based cohort study, higher arterial stiffness was associated with worse LV diastolic function in men and women. Women’s higher arterial stiffness, independent of body size, may contribute to their greater susceptibility to develop HFNEF.