Central Aortic Stiffness is Increased in Patients With Heart Failure and Preserved Ejection Fraction
Central Aortic Stiffness is Increased in Patients With Heart Failure and Preserved Ejection Fraction
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DOI：
10.1016/j.cardfail.2009.03.006
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发表时间：
2009-10-01
影响因子：
6
通讯作者：
Creager, Mark A.
中科院分区：
文献类型：
--
作者：
Desai, Akshay S.;Mitchell, Gary F.;Creager, Mark A.
背景：高血压是保留射血分数的心力衰竭发生的重要危险因素。虽然高血压患者的心力衰竭通常归因于内在的心肌异常，但非心脏因素也可能起作用。方法和结果：采用动脉血压计和多普勒超声心动图，我们评估了53例射血分数> =0.50的患者的动脉硬度和心脏舒张功能，其中23例高血压但无心力衰竭，16例高血压并心力衰竭，14例健康、血压正常的对照组。与健康对照组和高血压患者相比，心力衰竭患者的收缩压、体重指数、肌酐和左心室质量更高。心肌舒张速度测定各组间舒张功能差异无统计学意义。外周动脉僵硬度在所有组中相似，但中央主动脉僵硬度的关键指标（颈-股脉波速度、特征阻抗、前向波幅）随着从健康到高血压到心力衰竭的进展稳步增加，尽管调整了体重指数、收缩压和肾功能，但与左心室质量和充血压力均呈正相关。结论：我们得出的结论是，与年龄匹配的健康和无心力衰竭的高血压患者相比，心力衰竭和保留射血分数的患者中央主动脉硬度增加。这些变化超过了舒张功能的差异，表明异常的心室-血管耦合可能有助于保持射血分数的心力衰竭的病理生理。[J] [c]; 2009;15:658-664。]
Background: Hypertension is an important risk factor for the development of heart failure with preserved ejection fraction. Although heart failure in hypertensive patients is usually ascribed to intrinsic myocardial abnormalities, noncardiac factors may contribute.Methods and Results: Using arterial tonometry and Doppler echocardiography, we assessed arterial stiffness and cardiac diastolic function in 53 individuals with ejection fraction > =0.50, including 23 with hypertension but no heart failure, 16 with hypertension and heart failure, and 14 healthy, normotensive controls. Relative to healthy controls and hypertensives, subjects with heart failure had higher systolic blood pressure, body mass index, creatinine, and left ventricular mass. Diastolic function, as estimated by myocardial relaxation velocity, was not different among the 3 groups. Peripheral arterial stiffness was similar across all groups, but key measures of central aortic stiffness (carotid-femoral pulse wave velocity, characteristic impedance, forward wave amplitude) steadily increased with progression from healthy to hypertensive to heart failure despite adjustment for body mass index, systolic blood pressure, and renal function and were positively correlated with both left ventricular mass and filling pressure.Conclusions: We conclude that patients with heart failure and preserved ejection fraction have increased central aortic stiffness relative to age-matched healthy and hypertensive subjects without heart failure. These changes exceed differences in diastolic function and suggest that abnormal ventricular-vascular coupling may contribute to the pathophysiology of heart failure with preserved ejection fraction. (J Curdiac Fail 2009;15:658-664)