Tartière J-M, Logeart D, Safar M E, Cohen-Solal A
Department of Cardiology, Beaujon Hospital, Clichy, France.
J Hum Hypertens. 2006 Mar;20(3):213-9. doi: 10.1038/sj.jhh.1001965.
Pulse wave velocity (PWV), the carotid augmentation index (AIx), and pulse pressure (PP) may be prognostic factors in heart failure, but the possible influence of the ejection fraction (EF) and other simple haemodynamic variables on them has not been investigated in this setting. Noninvasive methods were used to measure carotid-radial (CR), carotid-femoral (CF) PWV and AIx, and brachial PP, in 135 consecutive patients with stable symptomatic chronic heart failure. The patients were divided into two groups, with preserved (>or=40%) or reduced (<40%) EF. CF-PWV, AIx and PP were lower in the decreased EF group (8.85+/-2.77 versus 10.60+/-2.75 m/s, P<0.001; 121+/-21 versus 132+/-24, P=0.009 and 41+/-19 versus 67+/-17 mmHg, P<0.001), but CR-PWV values were similar regardless of the EF status. These results were not modified after adjustment for age and sex. Multiple regression analysis showed that AIx and PP were systematically related to time domain parameters (heart rate or ejection duration) and EF, whatever the group. CF-PWV was weakly related to time domain values and unrelated to mean blood pressure (BP) or EF in the preserved EF group, whereas it was related to both mean BP and EF in the low EF group. In conclusion, whatever the EF level, PP and AIx were strongly modulated in the time domain, by pressure and by the EF level. The same relationships were found with CF-PWV, but only in the reduced EF group. Whether CF-PWV is the best prognostic factor in patients with 'diastolic' heart failure must be confirmed in a prospective study.
脉搏波速度（PWV）、颈动脉增强指数（AIx）和脉压（PP）可能是心力衰竭的预后因素，但射血分数（EF）和其他简单血流动力学变量对它们的可能影响在这种情况下尚未得到研究。采用非侵入性方法对135例症状稳定的慢性心力衰竭连续患者测量了颈-桡（CR）、颈-股（CF）脉搏波速度、AIx以及肱动脉脉压。患者被分为两组，射血分数保留（≥40%）或降低（<40%）。在射血分数降低组中，CF-PWV、AIx和PP较低（分别为8.85±2.77与10.60±2.75 m/s，P<0.001；121±21与132±24，P=0.009；41±19与67±17 mmHg，P<0.001），但无论EF状态如何，CR-PWV值相似。在对年龄和性别进行校正后，这些结果没有改变。多元回归分析表明，无论哪一组，AIx和PP都与时域参数（心率或射血持续时间）和EF系统相关。在射血分数保留组中，CF-PWV与时域值弱相关，与平均血压（BP）或EF无关，而在低EF组中，它与平均BP和EF均相关。总之，无论EF水平如何，PP和AIx在时域中均受到压力和EF水平的强烈调节。CF-PWV也存在相同的关系，但仅在射血分数降低组中。CF-PWV是否是“舒张性”心力衰竭患者的最佳预后因素，必须在前瞻性研究中得到证实。
