Pôle cardiovasculaire, médecine vasculaire-HTA, hôpital européen Georges-Pompidou, Paris Research Cardiovascular Center, Inserm 633, 20, rue Leblanc, 75015 Paris, France.
Diagn Interv Imaging. 2013 May;94(5):561-9. doi: 10.1016/j.diii.2013.01.025. Epub 2013 Apr 22.
Peripheral vascular disease is a frequently occurring disease and is most often caused by atherosclerosis and more rarely by anomalies of the collagen or other components of the arterial wall. Arterial stiffness problems form one of the precursor phenomena of peripheral vascular disease, and in the case of atherosclerosis represents an independent risk marker for the occurrence of cardiovascular disease. The first techniques, developed to evaluate arterial stiffness, use indirect measurements such as pulse wave velocity or the analysis of variations in pressure and volume to estimate arterial wall stiffness. Techniques based on the pulse wave lack precision because they assume that arterial stiffness is uniform throughout the path of the pulse wave, and that it is constant throughout the cardiac cycle. Moreover, measuring the velocity of the pulse wave may be less precise in certain pathological situations: metabolic syndrome, obesity, large chest, mega-dolico artery. Techniques based on the analysis of variations in pressure and in volume do not accurately measure blood pressure, which can only be taken externally. In addition, these techniques require dedicated equipment, which is not reimbursed by the French health care system, and which is cumbersome to use (especially for techniques based on variation in pressure) in clinical practice. This explains why these two techniques are not used in clinical practice. Ultrafast echography is a new ultrasound imaging method that can record up to 10,000 images per second. This high temporal resolution makes it possible to measure the velocity of the local pulse wave and arterial wall stiffness thanks to the remote palpation carried out by shear wave. The ease of use and the accuracy of these two techniques suggest that these diagnostic applications will play a significant role in vascular pathology in the future. It is possible in real time, using a traditional vascular ultrasound probe, to make an accurate assessment of local arterial stiffness and of its variation during the cardiac cycle. This technological breakthrough will probably improve phenotype evaluation of patients suffering from vascular diseases, to more effectively evaluate the cardiovascular risk for patients, at primary and secondary prevention level, and to carry out broad epidemiological studies on cardiovascular risks.
外周血管疾病是一种常见疾病，通常由动脉粥样硬化引起，较少由动脉壁胶原或其他成分的异常引起。动脉僵硬度问题是外周血管疾病的前体现象之一，在动脉粥样硬化的情况下，它是心血管疾病发生的独立风险标志物。最初开发的评估动脉僵硬度的技术使用间接测量方法，如脉搏波速度或压力和体积变化的分析，以估计动脉壁僵硬度。基于脉搏波的技术缺乏精度，因为它们假设动脉僵硬度在整个脉搏波路径上是均匀的，并且在整个心动周期中是恒定的。此外，在某些病理情况下，测量脉搏波速度可能不太精确：代谢综合征、肥胖、大胸、大长肌动脉。基于压力和体积变化分析的技术不能准确测量血压，只能通过外部测量。此外，这些技术需要专用设备，法国的医疗保健系统不报销这些设备，而且在临床实践中使用起来很麻烦（特别是基于压力变化的技术）。这就是为什么这两种技术没有在临床实践中使用的原因。超快速超声心动图是一种新的超声成像方法，每秒可以记录多达 10000 个图像。这种高时间分辨率使得通过剪切波进行的远程触诊可以测量局部脉搏波速度和动脉壁僵硬度。这两种技术的易用性和准确性表明，这些诊断应用在未来的血管病理学中将发挥重要作用。使用传统的血管超声探头，可以实时准确地评估局部动脉僵硬度及其在心动周期中的变化。这项技术突破可能会改善患有血管疾病的患者的表型评估，更有效地评估患者的心血管风险，在一级和二级预防水平，并进行广泛的心血管风险的流行病学研究。
