Department of Medicine, Columbia University, College of Physicians & Surgeons, 630 West 168th Street, New York, NY 10032, USA.
J Hypertens. 2011 Mar;29(3):574-82. doi: 10.1097/HJH.0b013e328342ca56.
Increased arterial wave reflection is a predictor of cardiovascular events and has been hypothesized to be a cofactor in the pathophysiology of heart failure. Whether increased wave reflection is inversely associated with left-ventricular (LV) systolic function in individuals without heart failure is not clear.
Arterial wave reflection and LV systolic function were assessed in 301 participants from the Cardiovascular Abnormalities and Brain Lesions (CABL) study using two-dimensional echocardiography and applanation tonometry of the radial artery to derive central arterial waveform by a validated transfer function. Aortic augmentation index (AIx) and wasted energy index (WEi) were used as indices of wave reflection. LV systolic function was measured by LV ejection fraction (LVEF) and tissue Doppler imaging (TDI). Mitral annulus peak systolic velocity (Sm), peak longitudinal strain and strain rate were measured. Participants with history of coronary artery disease, atrial fibrillation, LVEF less than 50% or wall motion abnormalities were excluded.
Mean age of the study population was 68.3 ± 10.2 years (64.1% women, 65% hypertensive). LV systolic function by TDI was lower with increasing wave reflection, whereas LVEF was not. In multivariate analysis, TDI parameters of LV longitudinal systolic function were significantly and inversely correlated to AIx and WEi (P values from 0.05 to 0.002).
In a community cohort without heart failure and with normal LVEF, an increased arterial wave reflection was associated with subclinical reduction in LV systolic function assessed by novel TDI techniques. Further studies are needed to investigate the prognostic implications of this relationship.
动脉波反射增加是心血管事件的预测因子，并被假设为心力衰竭病理生理学的一个因素。在没有心力衰竭的个体中，波反射增加是否与左心室（LV）收缩功能呈负相关尚不清楚。
使用二维超声心动图和桡动脉平板测压法评估来自心血管异常和脑病变（CABL）研究的 301 名参与者的动脉波反射和 LV 收缩功能，通过经过验证的传递函数得出中心动脉波形。主动脉增强指数（AIx）和浪费能量指数（WEi）被用作波反射的指标。LV 收缩功能通过 LV 射血分数（LVEF）和组织多普勒成像（TDI）来测量。测量二尖瓣环收缩期峰值速度（Sm）、峰值纵向应变和应变率。排除有冠心病史、心房颤动、LVEF 小于 50%或壁运动异常的患者。
研究人群的平均年龄为 68.3±10.2 岁（64.1%为女性，65%为高血压患者）。随着波反射的增加，TDI 测量的 LV 收缩功能降低，而 LVEF 则没有。在多变量分析中，LV 纵向收缩功能的 TDI 参数与 AIx 和 WEi 呈显著负相关（P 值从 0.05 到 0.002）。
在一个没有心力衰竭且 LVEF 正常的社区队列中，动脉波反射增加与使用新型 TDI 技术评估的 LV 收缩功能的亚临床降低相关。需要进一步研究来探讨这种关系的预后意义。
