Ooi Henry, Chung William, Biolo Andreia
Vanderbilt University Medical Center and the Veterans' Administration Medical Center, Nashville, TN 37232, USA.
Congest Heart Fail. 2008 Jan-Feb;14(1):31-6. doi: 10.1111/j.1751-7133.2008.07210.x.
Vascular load is an important determinant of ventricular function. This is particularly true of the failing heart, which is exquisitely load-sensitive. Vascular load comprises 2 major components: resistive load, which arises primarily at the arteriolar resistance vessels, and pulsatile load, which is primarily determined by aortic stiffness and early return of reflected waves from the periphery to the heart. Assessment of pulsatile load is gaining increasing prominence as evidence grows of a significant pathophysiologic role for arterial stiffness in cardiovascular disease, including heart failure. Assessment of arterial stiffness and vascular load is reviewed here. The importance of optimal ventricular-vascular coupling to maximize the efficiency of cardiac ejection is discussed. Current knowledge of arterial stiffness, vascular load, and ventricular-vascular coupling in systolic heart failure and in heart failure with a normal ejection fraction ("diastolic failure") is described. Reducing aortic stiffness may form an important future therapeutic target in patients with heart failure.
血管负荷是心室功能的重要决定因素。对于衰竭心脏而言尤其如此，衰竭心脏对负荷极为敏感。血管负荷包括两个主要成分：阻力负荷，主要产生于小动脉阻力血管；搏动负荷，主要由主动脉僵硬度以及反射波从外周早期返回心脏所决定。随着越来越多的证据表明动脉僵硬度在包括心力衰竭在内的心血管疾病中具有重要的病理生理作用，搏动负荷的评估日益受到关注。本文综述了动脉僵硬度和血管负荷的评估。讨论了优化心室 - 血管耦合以最大化心脏射血效率的重要性。描述了目前关于收缩性心力衰竭和射血分数正常的心力衰竭（“舒张性心力衰竭”）中动脉僵硬度、血管负荷和心室 - 血管耦合的知识。降低主动脉僵硬度可能成为未来心力衰竭患者的重要治疗靶点。
