普通人群中左心室收缩和舒张功能的多普勒指数与动脉僵硬度的关系。
Doppler indexes of left ventricular systolic and diastolic function in relation to the arterial stiffness in a general population.
作者信息
Cauwenberghs Nicholas, Knez Judita, Tikhonoff Valérie, D'hooge Jan, Kloch-Badelek Malgorzata, Thijs Lutgarde, Stolarz-Skrzypek Katarzyna, Haddad Francois, Wojciechowska Wiktoria, Swierblewska Ewa, Casiglia Edoardo, Kawecka-Jaszcz Kalina, Narkiewicz Krzysztof, Staessen Jan A, Kuznetsova Tatiana
机构信息
aDepartment of Cardiovascular Sciences, The Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, University of Leuven, Leuven, Belgium bThe Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy cDepartment of Cardiovascular Sciences, Division of Cardiovascular Imaging and Dynamics, University of Leuven, Leuven, Belgium dThe First Department of Cardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland eStanford Cardiovascular Institute, Stanford, California, USA fDepartment of Hypertension and Diabetology, Hypertension Unit, Medical University of Gdansk, Gdansk, Poland.
出版信息
J Hypertens. 2016 Apr;34(4):762-71. doi: 10.1097/HJH.0000000000000854.
BACKGROUND
Late-systolic loading of the left ventricular (LV) is determined by arterial wave reflections and central vascular stiffening. We, therefore, investigated the relationship between various Doppler indexes reflecting LV systolic and diastolic function and arterial stiffness in the framework of a large population study of randomly recruited study participants.
METHODS
In 1233 study participants (51.7% women; mean age, 48 years; 41.5% hypertensive), using conventional and tissue Doppler imaging, we measured: the transmitral early (E) and late (A) diastolic velocities; tissue Doppler imaging systolic and early (e') and late diastolic mitral annular velocities; and end-systolic longitudinal and radial strain. Using applanation tonometry, we assessed central pulse pressure (cPP), augmentation pressure and carotid-femoral pulse wave velocity.
RESULTS
After full adjustment, transmitral E and A peaks increased with augmentation pressure and cPP (P less than 0.0001) and e' was positively associated with cPP (P = 0.013). The E/e' ratio increased significantly with augmentation pressure (P less than 0.0001), cPP (P less than 0.0001) and pulse wave velocity (P = 0.048). Although accounting for covariables, all arterial indexes were on average significantly higher in the diastolic dysfunction group with elevated filling pressure (n = 171) when compared to participants with normal diastolic function (n = 961; P ≤ 0.0004) or with impaired relaxation (n = 101; P ≤ 0.008). Longitudinal strain decreased independently with mean arterial pressure (P = 0.03). The correlation between radial strain and the arterial indexes shifted from positive at middle age (50-60 years) to negative at older (P less than 0.0001 for interaction).
CONCLUSION
Our study underscored the importance of arterial characteristics as a mediator of LV systolic and diastolic dysfunction. We demonstrated an age-dependent relationship between radial strain and indexes of arterial stiffness.
背景
左心室（LV）收缩晚期负荷由动脉波反射和中心血管僵硬度决定。因此，在一项对随机招募的研究参与者进行的大规模人群研究框架内，我们研究了反映左心室收缩和舒张功能的各种多普勒指标与动脉僵硬度之间的关系。
方法
在1233名研究参与者（51.7%为女性；平均年龄48岁；41.5%为高血压患者）中，我们使用传统和组织多普勒成像测量了：二尖瓣舒张早期（E）和晚期（A）速度；组织多普勒成像收缩期和舒张早期（e'）以及二尖瓣环舒张晚期速度；以及收缩末期纵向和径向应变。使用压平式眼压计，我们评估了中心脉压（cPP）、增强压和颈股脉搏波速度。
结果
在进行全面调整后，二尖瓣E峰和A峰随增强压和cPP升高（P<0.0001），且e'与cPP呈正相关（P=0.013）。E/e'比值随增强压（P<0.0001）、cPP（P<0.0001）和脉搏波速度（P=0.048）显著升高。尽管考虑了协变量，但与舒张功能正常的参与者（n=961；P≤0.0004）或舒张功能减退的参与者（n=101；P≤0.008）相比，舒张功能障碍且充盈压升高的组（n=171）中所有动脉指标平均显著更高。纵向应变随平均动脉压独立降低（P=0.03）。径向应变与动脉指标之间的相关性从中年（50 - 60岁）时的正相关转变为老年时的负相关（交互作用P<0.0001）。
结论
我们的研究强调了动脉特征作为左心室收缩和舒张功能障碍介导因素的重要性。我们证明了径向应变与动脉僵硬度指标之间存在年龄依赖性关系。
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