Kamimura Daisuke, Uchino Kazuaki, Ogawa Hideyuki, Shimizu Makoto, Shigemasa Tomohiko, Morita Yukiko, Kimura Kazuo, Umemura Satoshi
Department of Medical Science and Cardiorenal Medicine, Yokohama City University, Graduate School of Medicine, Yokohama, Japan.
Department of Cardiology, International Goodwill Hospital, Yokohama, Japan.
Hypertens Res. 2014 Jan;37(1):57-63. doi: 10.1038/hr.2013.111. Epub 2013 Sep 19.
A small proximal aortic diameter (AoD) is thought to be associated with a higher characteristic impedance of the proximal aorta. However, there has been no evidence of a relationship between directly evaluated AoD and directly measured central aortic pressure or the outcome of patients with cardiovascular diseases.
(a) In 135 patients without heart failure (HF), who underwent coronary catheterization, we retrospectively examined the relationship between the AoD and the central aortic pressure or aortic elastance. The AoD adjusted with covariates was inversely correlated with the central pulse pressure (cPP; coefficient=-0.75; P=0.04; model R(2)=0.575) and the effective arterial elastance index (coefficient=-0.12; P=0.001; model R(2)=0.366). (b) In 197 patients who were hospitalized due to HF, we examined the relationship between the AoD (evaluated using echocardiography) and the outcome using a Cox proportional hazard model. Fifty-three patients died from various causes during the follow-up period (2.2±1.1 years). Multivariable analysis revealed that the AoD remained an independent risk factor for all-cause death (hazard ratio for 1 s.d. increase of the AoD: 0.68, 95% confidence interval: 0.50-0.92, P=0.013) and cardiovascular death (hazard ratio for 1 s.d. increase of the AoD: 0.63, 95% confidence interval: 0.43-0.93, P=0.019).
A small AoD was associated with a higher cPP and aortic stiffening in the patients without HF, as well as with a poor outcome for HF patients. Although it is easy to evaluate the AoD, it may offer important information regarding the pulsatile load and may be useful for risk stratification of HF patients.
主动脉近端直径（AoD）较小被认为与主动脉近端较高的特征阻抗相关。然而，尚无证据表明直接评估的AoD与直接测量的中心主动脉压或心血管疾病患者的预后之间存在关联。
（a）在135例接受冠状动脉导管插入术的无心衰（HF）患者中，我们回顾性研究了AoD与中心主动脉压或主动脉弹性之间的关系。经协变量调整后的AoD与中心脉压（cPP；系数=-0.75；P=0.04；模型R²=0.575）和有效动脉弹性指数（系数=-0.12；P=0.001；模型R²=0.366）呈负相关。（b）在197例因HF住院的患者中，我们使用Cox比例风险模型研究了AoD（采用超声心动图评估）与预后之间的关系。53例患者在随访期（2.2±1.1年）内因各种原因死亡。多变量分析显示，AoD仍然是全因死亡（AoD每增加1个标准差的风险比：0.68，95%置信区间：0.50-0.92，P=0.013）和心血管死亡（AoD每增加1个标准差的风险比：0.63，95%置信区间：0.43-0.93，P=0.019）的独立危险因素。
AoD较小与无心衰患者较高的cPP和主动脉僵硬度相关，也与心衰患者的不良预后相关。尽管AoD易于评估，但它可能提供有关脉动负荷的重要信息，并且可能有助于心衰患者的风险分层。
