Schofield Richard S, Pierce Gary L, Nichols Wilmer W, Klodell Charles T, Aranda Juan M, Pauly Daniel F, Hill James A, Braith Randy W
Department of Veterans Affairs Medical Center, Gainesville, Florida, USA.
Am J Hypertens. 2007 Jun;20(6):622-8. doi: 10.1016/j.amjhyper.2006.12.015.
Chronic heart failure (HF) is associated with increased central arterial pulse-wave reflections, which may contribute to increased myocardial oxygen demand. Although the treatment of HF via left-ventricular assist device (LVAD) placement has recently become widespread, the effects of LVAD therapy on central arterial pulse-wave reflections are unknown.
Central aortic pulse-wave analysis was performed on patients with end-stage HF awaiting cardiac transplantation and on healthy age-matched controls using the SphygmoCor (Akor Medical, Sydney, Australia) system. Arterial pulse-wave data were compared between patients receiving LVAD support versus those receiving intravenous inotropic drugs and healthy control patients.
Five patients on LVAD support were compared with 10 patients on inotropic drugs and 10 healthy control patients. Aortic augmented pressure and the aortic augmentation index (AI(a)) were higher in LVAD patients compared with inotrope and control patients, despite similar brachial and aortic blood pressures between groups. The AI(a) was significantly higher in LVAD patients than in patients on inotropic drugs (28.2% +/- 10% v 7.9% +/- 9%, P < or = .01). Additionally, there was a significantly higher aortic systolic tension time index, an index of left-ventricular myocardial oxygen demand, in the LVAD group compared with the inotrope group (2655 +/- 298 mm Hg/sec/min v 1748 +/- 303 mm Hg/sec/min, P < .01).
Central arterial pressure-wave reflection is increased in end-stage HF patients on LVAD support compared with those on inotropic drugs, leading to an increase in aortic augmented pressure, AI(a), and systolic tension time index. The AI(a) is also higher in LVAD patients than in healthy controls. This increased central arterial-wave reflection places an additional hemodynamic load on the LVAD device and may have relevance to the medical management of patients after LVAD placement and to the longevity of the LVAD device itself.
慢性心力衰竭（HF）与中心动脉脉搏波反射增加有关，这可能导致心肌需氧量增加。尽管通过植入左心室辅助装置（LVAD）治疗HF最近已广泛应用，但LVAD治疗对中心动脉脉搏波反射的影响尚不清楚。
使用SphygmoCor（澳大利亚悉尼Akor Medical公司）系统，对等待心脏移植的终末期HF患者和年龄匹配的健康对照者进行中心主动脉脉搏波分析。比较接受LVAD支持的患者、接受静脉注射正性肌力药物的患者和健康对照患者的动脉脉搏波数据。
将5例接受LVAD支持的患者与10例接受正性肌力药物治疗的患者和10例健康对照患者进行比较。尽管各组之间肱动脉和主动脉血压相似，但LVAD患者的主动脉增强压和主动脉增强指数（AI(a)）高于接受正性肌力药物治疗的患者和对照患者。LVAD患者的AI(a)显著高于接受正性肌力药物治疗的患者（28.2%±10%对7.9%±9%，P≤0.01）。此外，与正性肌力药物组相比，LVAD组的主动脉收缩张力时间指数（左心室心肌需氧量指标）显著更高（2655±298 mmHg/秒/分钟对1748±303 mmHg/秒/分钟，P<0.01）。
与接受正性肌力药物治疗的终末期HF患者相比，接受LVAD支持的患者中心动脉压力波反射增加，导致主动脉增强压、AI(a)和收缩张力时间指数升高。LVAD患者的AI(a)也高于健康对照者。这种中心动脉波反射增加给LVAD装置带来了额外的血流动力学负荷，可能与LVAD植入后患者的医疗管理以及LVAD装置本身的使用寿命有关。
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