Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, FL 32610, USA.
Circ Heart Fail. 2010 Jan;3(1):149-56. doi: 10.1161/CIRCHEARTFAILURE.109.862383. Epub 2009 Nov 10.
The effect of moderate left ventricular systolic dysfunction (LVSD) on ventricular/vascular coupling and the aortic pressure waveform (AoPW) has been well described, but the effect of severe LVSD has not.
We used noninvasive, high-fidelity tonometry of the radial artery and a mathematical transfer function to generate the AoPW in 25 treated patients with LVSD (mean LV ejection fraction, 24+/-8.8%; range, 11% to 40%; 21 patients <30%). Pulse wave analysis of the AoPW was used to characterize ventricular/vascular coupling and compared with pulse wave analysis performed in 25 normal subjects matched for age, gender, height, body mass index, and heart rate. Measurements obtained using pulse wave analysis in LVSD patients indicated features of poor LV stroke performance and also reduced indices of arterial stiffness: increased travel time of the pressure wave (147+/-10 ms versus 132+/-21 ms; P<0.001); decreased systolic duration of reflected wave (134+/-24 ms versus 167+/-26 ms; P<0.001); ejection duration (277+/-22 ms versus 299+/-25 ms; P<0.008); percent systolic duration (32+/-5.3% versus 35+/-4.0%; P<0.02); aortic systolic pressure (100+/-16 mm Hg versus 121+/-16 mm Hg; P<0.001); unaugmented pressure (24+/-6.3 mm Hg versus 32+/-6.4 mm Hg; P<0.001); augmented pressure (4.8+/-3.1 mm Hg versus 9.6+/-4.5 mm Hg; P<0.001); pulse pressure (28+/-7.4 mm Hg versus 42+/-9.5 mm Hg; P<0.001); augmentation index (12+/-6.6% versus 23+/-7.6%; P<0.006); wasted LV effort (5.3+/-2.8x10(2) dyne sec/cm(2) versus 17+/-10x10(2) dyne sec/cm(2); P<0.001); systolic pressure time index (17+/-4.1x10(2) mm Hg-sec/min versus 23+/-4.2x10(2) mm Hg sec/min; P<0.001); and pressure systolic area (383+/-121 mm Hg sec/min versus 666+/-150 mm Hg sec/min; P<0.001).
Severe LVSD causes measurable changes in the AoPW. Standardization of AoPW findings in LVSD patients may allow for the clinical use of radial artery pulse wave analysis to noninvasively determine the severity of dysfunction and aid in logical therapy.
中度左心室收缩功能障碍（LVSD）对心室/血管耦联和主动脉压力波（AoPW）的影响已有很好的描述，但严重 LVSD 的影响尚未阐明。
我们使用桡动脉的非侵入性、高保真测压和数学传递函数来生成 25 例 LVSD 治疗患者的 AoPW（平均 LV 射血分数，24±8.8%；范围，11%至 40%；21 例患者<30%）。AoPW 的脉搏波分析用于描述心室/血管耦联，并与 25 例年龄、性别、身高、体重指数和心率匹配的正常受试者的脉搏波分析进行比较。LVSD 患者的脉搏波分析测量结果表明 LV 收缩性能较差，并降低了动脉僵硬度的指标：压力波传播时间增加（147±10ms 与 132±21ms；P<0.001）；反射波收缩持续时间减少（134±24ms 与 167±26ms；P<0.001）；射血持续时间（277±22ms 与 299±25ms；P<0.008）；收缩期持续时间百分比（32±5.3%与 35±4.0%；P<0.02）；主动脉收缩压（100±16mmHg 与 121±16mmHg；P<0.001）；未增强压力（24±6.3mmHg 与 32±6.4mmHg；P<0.001）；增强压力（4.8±3.1mmHg 与 9.6±4.5mmHg；P<0.001）；脉压（28±7.4mmHg 与 42±9.5mmHg；P<0.001）；增强指数（12±6.6%与 23±7.6%；P<0.006）；LV 浪费的功（5.3±2.8x10(2)dyne sec/cm(2)与 17±10x10(2)dyne sec/cm(2)；P<0.001）；收缩压时间指数（17±4.1x10(2)mmHg-sec/min 与 23±4.2x10(2)mmHg sec/min；P<0.001）；和压力收缩面积（383±121mmHg sec/min 与 666±150mmHg sec/min；P<0.001）。
严重的 LVSD 导致 AoPW 发生可测量的变化。LVSD 患者 AoPW 结果的标准化可能允许使用桡动脉脉搏波分析进行临床应用，以无创性确定功能障碍的严重程度，并有助于进行合理的治疗。
