Ventricular-arterial coupling: Invasive and non-invasive assessment.
Ventricular-arterial coupling: Invasive and non-invasive assessment.
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DOI：
10.1016/j.artres.2012.12.002
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发表时间：
2013-03
期刊：
影响因子：
0.6
通讯作者：
Chirinos, Julio A
中科院分区：
文献类型：
--
作者：
Chirinos, Julio A
左心室(LV)和动脉系统之间的相互作用(室-动脉耦合)是心血管功能的关键决定因素。在压力-体积平面上，最常使用有效动脉弹性(EA)与左心室收缩末期弹性(EES)之比来评估室间动脉耦合。Ea(通常解释为动脉负荷的综合指数)可以计算为收缩末期压力/每搏输出量，而EES(与负荷无关的左心腔收缩僵硬和收缩能力的测量)是使用急性前负荷改变期间获得的一系列压力-容量环路的数据进行无创性评估的理想方法。还提出了单搏动方法，允许使用简单的超声心动图测量来非侵入性地估计EES。Ea/Ees比值是有用的，因为它提供了有关心室-动脉系统的操作机械效率和性能的信息。然而，应该认识到，在压力-体积平面上的分析有几个局限性，而且“心室-动脉耦合”包括多个生理方面，其中许多不能在压力-体积平面上捕捉到。因此，额外的评估提供了关于心血管系统的重要的增量生理学信息，应该得到更广泛的应用。特别是，应该认识到：(1)全面的动脉负荷分析很重要，因为电针不能很好地表征搏动性左心室负荷，而不是完全依赖于动脉的特性；(2)收缩负荷序列是室-动脉耦合的一个重要方面，被压力-容量分析忽视，并可能深刻地影响左心功能、重构和心力衰竭的进展。这篇简短的综述总结了动脉12次会议(2012年10月)上讨论的评估心室-动脉相互作用的方法。
Interactions between the left ventricle (LV) and the arterial system, (ventricular–arterial coupling) are key determinants of cardiovascular function. Ventricularearterial coupling is most frequently assessed in the pressure–volume plane using the ratio of effective arterial elastance (EA) to LV end-systolic elastance (EES). EA (usually interpreted as a lumped index of arterial load) can be computed as end-systolic pressure/stroke volume, whereas EES (a load-independent measure of LV chamber systolic stiffness and contractility) is ideally assessed invasively using data from a family of pressure–volume loops obtained during an acute preload alteration. Single-beat methods have also been proposed, allowing for non-invasive estimations of EES using simple echocardiographic measurements. The EA/EES ratio is useful because it provides information regarding the operating mechanical efficiency and performance of the ventricular–arterial system. However, it should be recognized that analyses in the pressure–volume plane have several limitations and that “ventricular–arterial coupling” encompasses multiple physiologic aspects, many of which are not captured in the pressure–volume plane. Therefore, additional assessments provide important incremental physiologic information about the cardiovascular system and should be more widely used. In particular, it should be recognized that: (1) comprehensive analyses of arterial load are important because EA poorly characterizes pulsatile LV load and does not depend exclusively on arterial properties; (2) The systolic loading sequence, an important aspect of ventricular–arterial coupling, is neglected by pressure–volume analyses, and can profoundly impact LV function, remodeling and progression to heart failure. This brief review summarizes methods for the assessment of ventricular–arterial interactions, as discussed at the Artery 12 meeting (October 2012).