Central Hemodynamics for Management of Arteriosclerotic Diseases.
Central Hemodynamics for Management of Arteriosclerotic Diseases.
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DOI：
10.5551/jat.40717
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发表时间：
2017-08-01
影响因子：
4.4
通讯作者：
Hashimoto J
中科院分区：
文献类型：
--
作者：
Hashimoto J
动脉炎，特别是动脉硬化，是与心血管、脑血管和肾脏疾病相关的最关键的危险因素。中央主动脉中的脉动血液动力学由血压、流量和刚度组成，并且与肌性动脉中的外周血液动力学显著不同。随着年龄的变化出现在弹性主动脉，年龄依赖性的增加，中心脉压更显着比那些明显的肱动脉压力测量。生活习惯、代谢紊乱、内分泌和炎症性疾病会以不同于肱动脉压的方式影响中心压。由于主动脉硬化导致的中心脉压增宽增加了收缩期左心室后负荷，减少了冠状动脉血流，使动脉粥样硬化患者易发生心肌肥大和缺血。变宽的脉压也会深入到低阻抗器官，如大脑和肾脏，引起微血管损伤，导致腔隙性中风和蛋白尿。此外，主动脉硬化增加主动脉血流逆转，这可导致逆行栓塞性卒中和肾功能恶化。在大多数先前的研究中，中心压已被证明可以预测心血管事件，并可能作为干预的替代标志物。现在可以通过各种无创压力/流量测量方式对中枢血流动力学进行定量和全面的评价。本综述将重点介绍中心血流动力学测量在心血管风险管理中的临床实用性和机制原理。
Arteriosclerosis, particularly aortosclerosis, is the most critical risk factor associated with cardiovascular, cerebrovascular, and renal diseases. The pulsatile hemodynamics in the central aorta consists of blood pressure, flow, and stiffness and substantially differs from the peripheral hemodynamics in muscular arteries. Arteriosclerotic changes with age appear earlier in the elastic aorta, and age-dependent increases in central pulse pressure are more marked than those apparent from brachial pressure measurement. Central pressure can be affected by lifestyle habits, metabolic disorders, and endocrine and inflammatory diseases in a manner different from brachial pressure. Central pulse pressure widening due to aortic stiffening increases left ventricular afterload in systole and reduces coronary artery flow in diastole, predisposing aortosclerotic patients to myocardial hypertrophy and ischemia. The widened pulse pressure is also transmitted deep into low-impedance organs such as the brain and kidney, causing microvascular damage responsible for lacunar stroke and albuminuria. In addition, aortic stiffening increases aortic blood flow reversal, which can lead to retrograde embolic stroke and renal function deterioration. Central pressure has been shown to predict cardiovascular events in most previous studies and potentially serves as a surrogate marker for intervention. Quantitative and comprehensive evaluation of central hemodynamics is now available through various noninvasive pressure/flow measurement modalities. This review will focus on the clinical usefulness and mechanistic rationale of central hemodynamic measurements for cardiovascular risk management.