Department of Cardiology, Klinikum Wels-Grieskirchen, Austria.
University of Pennsylvania School of Medicine/Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Eur Heart J. 2018 Nov 14;39(43):3847-3854. doi: 10.1093/eurheartj/ehy346.
Due to the cyclic function of the human heart, pressure and flow in the circulation are pulsatile rather than continuous. Addressing pulsatile haemodynamics starts with the most convenient measurement, brachial pulse pressure, which is widely available, related to development and treatment of heart failure (HF), but often confounded in patients with established HF. The next level of analysis consists of central (rather than brachial) pressures and, more importantly, of wave reflections. The latter are closely related to left ventricular late systolic afterload, ventricular remodelling, diastolic dysfunction, exercise capacity, and, in the long-term, the risk of new-onset HF. Wave reflection may also represent a suitable therapeutic target. Treatments for HF with preserved and reduced ejection fraction, based on a reduction of wave reflection, are emerging. A full understanding of ventricular-arterial coupling, however, requires dedicated analysis of time-resolved pressure and flow signals, which can be readily accomplished with contemporary non-invasive imaging and modelling techniques. This review provides a summary of our current understanding of pulsatile haemodynamics in HF.
由于人体心脏的循环功能，循环中的压力和流量是脉动的而不是连续的。解决脉动血液动力学问题首先要从最方便的测量方法——肱动脉脉搏压入手，肱动脉脉搏压广泛可用，与心力衰竭（HF）的发生和治疗有关，但在已确诊 HF 的患者中常常受到干扰。下一个分析层次包括中心（而不是肱动脉）压力，更重要的是波反射。后者与左心室收缩后期后负荷、心室重构、舒张功能障碍、运动能力密切相关，从长远来看，还与新发 HF 的风险相关。波反射也可能是一个合适的治疗靶点。基于降低波反射的治疗方法正在出现，用于治疗射血分数保留和降低的心力衰竭。然而，要全面了解心室-动脉偶联，需要对时变压力和流量信号进行专门分析，这可以通过当代的非侵入性成像和建模技术轻松实现。这篇综述总结了我们目前对 HF 中脉动血液动力学的理解。
