The role of ventricular-arterial coupling in cardiac disease and heart failure: assessment, clinical implications and therapeutic interventions. A consensus document of the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases, European Association of Cardiovascular Imaging, and Heart Failure Association
The role of ventricular-arterial coupling in cardiac disease and heart failure: assessment, clinical implications and therapeutic interventions. A consensus document of the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases, European Association of Cardiovascular Imaging, and Heart Failure Association
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DOI：
10.1002/ejhf.1436
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发表时间：
2019-04-01
影响因子：
18.2
通讯作者：
Metra, Marco
中科院分区：
文献类型：
--
作者：
Ikonomidis, Ignatios;Aboyans, Victor;Metra, Marco
血管-动脉耦合（VAC）在心脏和主动脉力学生理学以及心脏疾病的病理生理学中起着重要作用。VAC评估具有独立的诊断和预后价值，可用于细化风险分层和监测治疗干预。传统上，通过无创测量动脉（Ea）与心室收缩末期弹性（Ees）的比值来评估VAC。随着疾病的进展，Ea和Ees都可能变得异常，Ea/Ees比值可能接近其正常值。因此，测量该比率的每个分量或心肌（例如，全局纵向应变）和动脉功能（例如，脉搏波速度）的新的更灵敏的标记物可以更好地表征VAC。在心脏瓣膜病中，全身动脉顺应性和瓣膜动脉阻抗具有确定的诊断和预后价值，并可监测瓣膜置换术对血管和心脏功能的影响。通过改善VAC的两个或每一个组成部分来改善VAC的治疗可能会延迟心力衰竭的发生率，并可能改善心力衰竭的预后。在本共识文件中，我们描述了VAC在心脏病和心力衰竭中的病理生理学、评估方法以及临床意义。最后，我们关注可能改善VAC从而改变预后的干预措施。
Ventricular-arterial coupling (VAC) plays a major role in the physiology of cardiac and aortic mechanics, as well as in the pathophysiology of cardiac disease. VAC assessment possesses independent diagnostic and prognostic value and may be used to refine riskstratification and monitor therapeutic interventions. Traditionally, VAC is assessed by the non-invasive measurement of the ratio of arterial (Ea) to ventricular end-systolic elastance (Ees). With disease progression, both Ea and Ees may become abnormal and the Ea/Ees ratio may approximate its normal values. Therefore, the measurement of each component of this ratio or of novel more sensitive markers of myocardial (e.g. global longitudinal strain) and arterial function (e.g. pulse wave velocity) may better characterize VAC. In valvular heart disease, systemic arterial compliance and valvulo-arterial impedance have an established diagnostic and prognostic value and may monitor the effects of valve replacement on vascular and cardiac function. Treatment guided to improve VAC through improvement of both or each one of its components may delay incidence of heart failure and possibly improve prognosis in heart failure. In this consensus document, we describe the pathophysiology, the methods of assessment as well as the clinical implications of VAC in cardiac diseases and heart failure. Finally, we focus on interventions that may improve VAC and thus modify prognosis.