Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech Ghent, University of Ghent, Ghent, Belgium.
J Am Coll Cardiol. 2019 Sep 3;74(9):1237-1263. doi: 10.1016/j.jacc.2019.07.012.
A healthy aorta exerts a powerful cushioning function, which limits arterial pulsatility and protects the microvasculature from potentially harmful fluctuations in pressure and blood flow. Large-artery (aortic) stiffening, which occurs with aging and various pathologic states, impairs this cushioning function, and has important consequences on cardiovascular health, including isolated systolic hypertension, excessive penetration of pulsatile energy into the microvasculature of target organs that operate at low vascular resistance, and abnormal ventricular-arterial interactions that promote left ventricular remodeling, dysfunction, and failure. Large-artery stiffness independently predicts cardiovascular risk and represents a high-priority therapeutic target to ameliorate the global burden of cardiovascular disease. This paper provides an overview of key physiologic and biophysical principles related to arterial stiffness, the impact of aortic stiffening on target organs, noninvasive methods for the measurement of arterial stiffness, mechanisms leading to aortic stiffening, therapeutic approaches to reduce it, and clinical applications of arterial stiffness measurements.
健康的主动脉具有强大的缓冲功能，可限制动脉搏动性，并保护微血管免受压力和血流潜在有害波动的影响。大动脉（主动脉）僵硬随着年龄的增长和各种病理状态而发生，损害了这种缓冲功能，对心血管健康有重要影响，包括孤立性收缩期高血压、脉动能量过多渗透到以低血管阻力运行的靶器官的微血管中、以及异常的心室-动脉相互作用，促进左心室重构、功能障碍和衰竭。大动脉僵硬独立预测心血管风险，是改善心血管疾病全球负担的高度优先治疗靶点。本文概述了与动脉僵硬相关的关键生理和生物物理原理、主动脉僵硬对靶器官的影响、动脉僵硬的无创测量方法、导致主动脉僵硬的机制、降低其的治疗方法以及动脉僵硬测量的临床应用。
