Aging is Associated With an Earlier Arrival of Reflected Waves Without a Distal Shift in Reflection Sites.
Aging is Associated With an Earlier Arrival of Reflected Waves Without a Distal Shift in Reflection Sites.
复制标题
衰老与反射位点无远端移位的反射波的早期到达有关。
DOI：
10.1161/jaha.116.003733
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发表时间：
2016-08-29
影响因子：
5.4
通讯作者：
Chirinos JA
中科院分区：
文献类型：
--
作者：
Phan TS;Li JK;Segers P;Reddy-Koppula M;Akers SR;Kuna ST;Gislason T;Pack AI;Chirinos JA
尽管随着年龄的增长，中心脉搏波速度（PWV）显著增加，但反射波传导时间（RWTT）（传统上定义为中心压力波形中的拐点（TINF）的时间）并未明显减少，导致反射部位“远端移位”的争议性主张。然而，TINF特别容易出现测量误差，并且不仅受波反射的影响，还受喷射模式的影响。我们评估了通过高级压力-流量分析评估的RWTT是否证明了预期的老化下降。我们研究了一组无心血管疾病的老年人（n=48;中位年龄48岁）和一组疑似/确诊心血管疾病的老年人（n=164; 61岁）。我们分别用颈动脉张力计和相位对比MRI测量中心压和血流。我们使用波分离分析（RWTTWSA）和部分分布管荷载（TL）模型（RWTTTL）评估RWTT。与以前的报告一致，TINF并没有随着年龄的增长而明显下降，尽管在这两个人群中PWV显着增加。然而，衰老与RWTTWSA（一般人群-15.0 ms/decade，P<0.001;临床人群-9.07 ms/decade，P=0.003）和RWTTTL（一般人群-15.8 ms/decade，P<0.001;临床人群-11.8 ms/decade，P<0.001）的显著降低相关。没有证据表明这两种方法的有效反射距离增加。TINF被证明是可靠地代表RWTT只有在高度不切实际的假设输入阻抗。 RWTT随着年龄的增长而下降，PWV增加，波反射的早期影响，反射部位没有远端移位。这些发现对我们理解波反射与衰老的作用具有重要意义。
Despite pronounced increases in central pulse wave velocity (PWV) with aging, reflected wave transit time (RWTT), traditionally defined as the timing of the inflection point (TINF) in the central pressure waveform, does not appreciably decrease, leading to the controversial proposition of a “distal‐shift” of reflection sites. TINF, however, is exceptionally prone to measurement error and is also affected by ejection pattern and not only by wave reflection. We assessed whether RWTT, assessed by advanced pressure‐flow analysis, demonstrates the expected decline with aging. We studied a sample of unselected adults without cardiovascular disease (n=48; median age 48 years) and a clinical population of older adults with suspected/established cardiovascular disease (n=164; 61 years). We measured central pressure and flow with carotid tonometry and phase‐contrast MRI, respectively. We assessed RWTT using wave‐separation analysis (RWTTWSA) and partially distributed tube‐load (TL) modeling (RWTTTL). Consistent with previous reports, TINF did not appreciably decrease with age despite pronounced increases in PWV in both populations. However, aging was associated with pronounced decreases in RWTTWSA (general population −15.0 ms/decade, P<0.001; clinical population −9.07 ms/decade, P=0.003) and RWTTTL (general −15.8 ms/decade, P<0.001; clinical −11.8 ms/decade, P<0.001). There was no evidence of an increased effective reflecting distance by either method. TINF was shown to reliably represent RWTT only under highly unrealistic assumptions about input impedance. RWTT declines with age in parallel with increased PWV, with earlier effects of wave reflections and without a distal shift in reflecting sites. These findings have important implications for our understanding of the role of wave reflections with aging.