Joshi Mithilesh, Tran Patrick, Barber Thomas M, Ayub Waqar, Kuehl Michael, Banerjee Prithwish
University Hospital Coventry and Warwickshire, Clifford Bridge Road, Coventry, CV2 2DX, UK.
Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.
Curr Heart Fail Rep. 2023 Jun;20(3):179-190. doi: 10.1007/s11897-023-00602-4. Epub 2023 May 9.
The contribution of the vasculature in the development and progression of heart failure (HF) syndromes is poorly understood and often neglected. Incorporating both arterial and venous systems, the vasculature plays a significant role in the regulation of blood flow throughout the body in meeting its metabolic requirements. A deterioration or imbalance between the cardiac and vascular interaction can precipitate acute decompensated HF in both preserved and reduced ejection fraction phenotypes. This is characterised by the increasingly recognised concept of ventricular-arterial coupling: a well-balanced relationship between ventricular and vascular stiffness, which has major implications in HF. Often, the cause of decompensation is unknown, with international guidelines mainly centred on arrhythmia, infection, acute coronary syndrome and its mechanical complications as common causes of decompensation; the vascular component is often underrecognised. A better understanding of the vascular contribution in cardiovascular failure can improve risk stratification, earlier diagnosis and facilitate earlier optimal treatment. This review focuses on the role of the vasculature by integrating the concepts of ventricular-arterial coupling, arterial stiffness and venous return in a failing heart.
血管系统在心力衰竭（HF）综合征发生发展中的作用尚未得到充分理解，且常被忽视。血管系统包括动脉和静脉系统，在调节全身血流以满足代谢需求方面发挥着重要作用。心脏与血管相互作用的恶化或失衡可在射血分数保留型和降低型心力衰竭中引发急性失代偿性HF。这一过程的特征是心室 - 动脉耦合这一概念越来越受到认可：心室和血管僵硬度之间的良好平衡关系，这对HF具有重要意义。通常，失代偿的原因不明，国际指南主要集中在心律失常、感染、急性冠状动脉综合征及其机械并发症作为失代偿的常见原因；血管因素常常未得到充分认识。更好地理解血管系统在心血管衰竭中的作用可以改善风险分层、早期诊断并促进早期优化治疗。本综述通过整合心室 - 动脉耦合、动脉僵硬度和静脉回流等概念，重点探讨血管系统在衰竭心脏中的作用。
