Ventricular-Arterial Coupling in Chronic Heart Failure.
Ventricular-Arterial Coupling in Chronic Heart Failure.
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DOI：
10.15420/cfr.2017:4:2
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发表时间：
2017-04-01
影响因子：
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通讯作者：
Sweitzer, Nancy
中科院分区：
文献类型：
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作者：
Chirinos, Julio A;Sweitzer, Nancy
左心室（LV）和动脉系统（心室-动脉耦合）之间的相互作用的措施是重要的，但认识不足的心血管表型在心力衰竭。通常在压力-容积平面中评估心室-动脉耦合，使用有效动脉弹性（EA）与LV收缩末期弹性（EES）的比值，以提供LV射血分数异常时心室-动脉系统机械效率和性能的信息。这些分析有明显的局限性，如忽略了收缩负荷序列，并在射血分数保留的心力衰竭（HFpEF）中提供的信息较少。EA几乎完全依赖于血管阻力和心率。搏动动脉血流动力学和时间分辨心肌壁应力的评估提供了关键的增量生理信息，应该更广泛地使用。脉动动脉负荷是HFpEF的一个有前途的治疗靶点。在这里，我们回顾各种方法来评估心室动脉相互作用，其病理生理和临床意义的心力衰竭。
Measures of interaction between the left ventricle (LV) and arterial system (ventricular-arterial coupling) are important but under-recognised cardiovascular phenotypes in heart failure. Ventriculo-arterial coupling is commonly assessed in the pressure-volume plane, using the ratio of effective arterial elastance (EA) to LV end-systolic elastance (EES) to provide information on ventricular-arterial system mechanical efficiency and performance when LV ejection fraction is abnormal. These analyses have significant limitations, such as neglecting systolic loading sequence, and are less informative in heart failure with preserved ejection fraction (HFpEF). EA is almost entirely dependent on vascular resistance and heart rate. Assessment of pulsatile arterial haemodynamics and time-resolved myocardial wall stress provide critical incremental physiological information and should be more widely utilised. Pulsatile arterial load represents a promising therapeutic target in HFpEF. Here, we review various approaches to assess ventricular-arterial interactions, and their pathophysiological and clinical implications in heart failure.