Echocardiographic Assessment of Large Artery Stiffness.
Echocardiographic Assessment of Large Artery Stiffness.
复制标题
大动脉僵硬度的超声心动图评估。
DOI：
10.1016/j.echo.2016.09.004
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发表时间：
2016
期刊：
影响因子：
--
通讯作者：
Chirinos,JulioA
中科院分区：
文献类型：
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作者：
Chirinos,JulioA
动脉壁僵硬度是心血管医学高度相关的表型。大动脉硬化是单纯收缩期高血压发病机制的关键因素，1这是一种主要影响老年人的疾病，是全球心血管疾病高负担的原因。2动脉硬化损害了导管动脉在心脏收缩期间调节左心室间歇性输送的每搏输出量的能力，从而增加了阻碍左心室射血的脉动液压负荷。3，4越来越多的人认识到脉动动脉负荷增加对射血分数保持的心力衰竭、射血分数降低的心力衰竭、高血压性心脏病和瓣膜性心脏病（特别是主动脉瓣狭窄）等疾病的不利影响。此外，考虑到动脉硬度对脉动血液动力学的影响，增加的大动脉硬度也会促进压力和流量脉动过度渗透到肾脏和大脑中，导致靶器官损伤。5动脉僵硬度受各种危险因素和导致心血管疾病的生物学过程的影响。动脉僵硬度随着年龄增长和各种疾病状态而增加，如高血压、糖尿病、肥胖、吸烟、高胆固醇血症、亚临床炎症6和肾脏疾病。7各种长期暴露会导致大动脉在数十年的时间内随着老化而加速硬化。8因此，动脉硬度的测量不仅提供了关于流行疾病影响的信息，而且还反映了数十年来暴露于风险因素的累积历史，就像血红蛋白A1 c水平反映了数月内累积的高血糖症暴露一样。然而，与血红蛋白A1 c不同的是，动脉硬化不仅是上游异常的“标志”，而且是各种心血管疾病的因果介导者。毫不奇怪，现有的研究表明，颈动脉-股动脉脉搏波速度（PWV），大动脉硬度的指数，独立地预测在临床和社区为基础的队列事件的心血管事件的风险。9-12
Arterial wall stiffness is a highly relevant phenotype for cardiovascular medicine. Large artery stiffening is a key element in the pathogenesis of isolated systolic hypertension, 1 a condition mainly affecting older adults, which is responsible for a high burden of cardiovascular disease worldwide. 2 Arterial stiffening impairs the ability of conduit arteries to accommodate the stroke volume intermittently delivered by the left ventricle during systole, thus increasing the pulsatile hydraulic load impeding left ventricular ejection. 3, 4 There is increasing recognition of the adverse influence of increased pulsatile arterial load in conditions such as heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, hypertensive heart disease, and valvular heart disease (particularly aortic stenosis). In addition, given the effect of arterial stiffness on pulsatile hemodynamics, increased large artery stiffness can also promote excessive penetration of pressure and flow pulsatility into the kidney and the brain, leading to target organ damage. 5Arterial stiffness is affected by various risk factors and biologic processes that lead to cardiovascular disease. Arterial stiffness increases with aging and various disease states, such as hypertension, diabetes mellitus, obesity, smoking, hypercholesterolemia, subclinical inflammation, 6 and kidney disease. 7 Various long-term exposures lead to an accelerated stiffening of large arteries with aging over a period of decades. 8 Therefore, measurements of arterial stiffness not only provide information about the effects of prevalent conditions but also reflect the cumulative history of exposure to risk factors over a period of decades, much like hemoglobin A1c levels reflect the cumulative exposure to hyperglycemia over a period of months. Unlike hemoglobin A1c, however, arterial stiffness is not only a “marker” of upstream abnormalities but also a causal mediator of various forms of cardiovascular disease. Not surprisingly, available studies demonstrate that carotid-femoral pulse-wave velocity (PWV), an index of large artery stiffness, independently predicts the risk for incident cardiovascular events in both clinical and community-based cohorts. 9-12