Cardiology Department, University Teaching Hospital, Klinikum Wels-Grieskirchen, Austria.
Biomedical systems, Center for Health and Bioresources, AIT - Austrian Institute of Technology, Vienna, Austria.
Am J Hypertens. 2018 Apr 13;31(5):574-581. doi: 10.1093/ajh/hpy001.
Pulsatile hemodynamics are associated with left ventricular filling pressures and diastolic dysfunction. We investigated their relationship with maximum workload and peak oxygen uptake (peak VO2) in patients with exertional dyspnea and preserved left ventricular ejection fraction (LVEF).
Radial waveforms from tonometry were processed with a transfer function, pulse wave analysis and wave separation analysis, yielding central aortic pressures and measures of forward (amplitude of forward wave-Pf) and reflected waves (augmentation index-AIx, augmentation pressure-AP, amplitude of backward wave-Pb) and their ratio (reflection magnitude). Aortic pulse wave velocity (aoPWV) was estimated with a validated formula from single-point waveforms. Ergospirometry for assessment of exercise capacity was performed on a bicycle ergometer, using a ramp protocol.
Sixty-six patients were included (43 females; mean age 66 years; 83% hypertensives; mean body mass index 28.3 kg/m2). Mean peak VO2 was 17.0 ml/min/kg, mean achieved maximum workload 104.5 watts (80.9% of a reference population). Maximum workload and peak VO2 showed significant inverse relationships with AIx, AP, Pb, and aoPWV (r = -0.26 to -0.57). In multiple adjusted regression models, brachial and aortic pulse pressure, AP, Pf, Pb, and aoPWV were significant independent predictors of maximum workload, whereas AP, AIx75, Pf, Pb, and aoPWV were independently related to peak VO2.
Pulsatile hemodynamics are independently associated with objective measures of exercise capacity in patients with normal LVEF.
脉动血流动力学与左心室充盈压和舒张功能障碍有关。我们研究了它们与运动性呼吸困难和左心室射血分数保留（LVEF）患者的最大工作量和峰值摄氧量（peak VO2）之间的关系。
通过传递函数、脉搏波分析和波分离分析处理张力计的径向波，得出中心主动脉压以及前向波（正向波幅度-Pf）和反射波（增强指数-AIx、增强压-AP、反向波幅度-Pb）及其比值（反射幅度）的测量值。主动脉脉搏波速度（aoPWV）采用单点波形验证公式进行估计。使用斜坡方案在自行车测功计上进行运动能力评估的心肺运动试验。
共纳入 66 例患者（43 例女性；平均年龄 66 岁；83%的高血压患者；平均体重指数 28.3kg/m2）。平均峰值 VO2 为 17.0ml/min/kg，平均达到的最大工作量为 104.5 瓦特（参考人群的 80.9%）。最大工作量和峰值 VO2 与 Aix、AP、Pb 和 aoPWV 呈显著负相关（r=-0.26 至-0.57）。在多变量调整回归模型中，肱动脉和主动脉脉压、AP、Pf、Pb 和 aoPWV 是最大工作量的独立预测因素，而 AP、Aix75、Pf、Pb 和 aoPWV 与峰值 VO2 独立相关。
在 LVEF 正常的患者中，脉动血流动力学与客观的运动能力测量值独立相关。
