Increased wave reflection and ejection duration in women with chest pain and nonobstructive coronary artery disease: ancillary study from the Women's Ischemia Syndrome Evaluation.
Increased wave reflection and ejection duration in women with chest pain and nonobstructive coronary artery disease: ancillary study from the Women's Ischemia Syndrome Evaluation.
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DOI：
10.1097/hjh.0b013e3283611bac
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发表时间：
2013-07
影响因子：
4.9
通讯作者：
Pepine CJ
中科院分区：
文献类型：
--
作者：
Nichols WW;Denardo SJ;Johnson BD;Sharaf BL;Bairey Merz CN;Pepine CJ
脉动波反射增加中心主动脉收缩压 (BP) 并增加收缩压时间积分 (SPTI)，从而增加左心室 (LV) 后负荷和心肌氧 (MVO2) 需求。当增加时，这种变化可能会导致心肌缺血和心绞痛，特别是当主动脉舒张时间缩短且心肌灌注压受损时。因此，我们检查了一组患有胸痛 (WISE) 且无阻塞性冠状动脉疾病 (CAD) 的女性的脉搏波反射特征和舒张时间。通过压平血压计记录桡动脉血压波形，并得出主动脉血压波形。将 WISE 参与者的数据与无胸痛的无症状女性（参考组）的数据进行比较，这些女性的年龄、身高、体重指数 (BMI)、平均动脉血压和心率 (HR) 相匹配。与参考组相比，WISE 参与者的主动脉收缩压、脉搏压以及射血持续时间 (ED) 较高。这些差异与增强指数 (AIx) 和反射压力波收缩期持续时间的增加有关。波反射特性的这些改变与 SPTI 和浪费的 LV 能量 (Ew) 的增加以及脉压放大、心肌活力比和舒张压时间分数 (DPTF) 的减少有关。无阻塞性 CAD 的 WISE 参与者的收缩波反射和舒张时间发生变化，从而增加左心室后负荷、MVO2 需求和 Ew，并有可能减少冠状动脉灌注。心血管功能的这些改变会导致 MVO2 供需不匹配，从而促进缺血和胸痛，并可能导致或增加未来不良心血管事件的严重程度。
Pulsatile wave reflections augment central aortic systolic blood pressure (BP) and increase systolic pressure time integral (SPTI) thereby increasing left ventricular (LV) afterload and myocardial oxygen (MVO2) demand. When increased, such changes may contribute to myocardial ischemia and angina pectoris, especially when aortic diastolic time is decreased and myocardial perfusion pressure jeopardized. Accordingly, we examined pulse wave reflection characteristics and diastolic timing in a subgroup of women with chest pain (WISE) and no obstructive coronary artery disease (CAD). Radial artery BP waveforms were recorded by applanation tonometry, and aortic BP waveforms derived. Data from WISE participants were compared with data from asymptomatic women (reference group) without chest pain matched for age, height, body mass index (BMI), mean arterial BP and heart rate (HR). Compared with the reference group, WISE participants had higher aortic systolic and pulse BP and ejection duration (ED). These differences were associated with an increase in, augmentation index (AIx), and reflected pressure wave systolic duration. These modifications in wave reflection characteristics were associated with an increase in SPTI and wasted LV energy (Ew) and a decrease in pulse pressure amplification, myocardial viability ratio, and diastolic pressure time fraction (DPTF). WISE participants with no obstructive CAD have changes in systolic wave reflections and diastolic timing that increase LV afterload, MVO2 demand, and Ew with the potential to reduce coronary artery perfusion. These alterations in cardiovascular function contribute to an undesirable mismatch in the MVO2 supply/demand that promotes ischemia and chest pain and may contribute to, or increase the severity of, future adverse cardiovascular events.