Rossi Valentina A, Nebunu Delia, Nägele Matthias P, Barthelmes Jens, Haider Thomas, Laptseva Natallia, Bitos Konstantinos, Kreysing Leonie, Frank Michelle, Enseleit Frank, Wilhelm Markus J, Dzemali Omer, Ruschitzka Frank, Sudano Isabella, Flammer Andreas J
Department of Cardiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Clinic for Cardiac Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Clin Res Cardiol. 2024 Aug 21. doi: 10.1007/s00392-024-02519-x.
A significant proportion of patients with heart failure (HF) progress to an advanced stage, which is associated with a substantial increase in morbidity and mortality. These patients may be eligible for advanced treatment strategies such as mechanical circulatory support with ventricular assist devices (VAD). Vascular dysfunction is a hallmark of heart failure pathophysiology and prognosis. However, whether and to what degree the hemodynamic benefits of VADs influence vascular function remain unknown.
In this study, we evaluated endothelial vascular function with flow-mediated vasodilatation (FMD) and with flicker-light induced retinal vasodilatation (FID). 34 patients with a VAD (age 58 ± 10 years, 85% male, 74% ischemic heart disease, 26 continuous-flow (CF)-LVAD, and 8 pulsatile biventricular (bi)-VAD) were compared to 34 propensity-matched patients (mean age 62 ± 9 years, 68% male, 59% ischemic heart disease) with advanced HF (AdvHF). Endothelial function of larger arteries (FMD) was significantly better in patients after VAD implantation compared to matched AdvHF patients (7.2 ± 4.6% vs. 5.0 ± 3.2%, p = 0.03), whereas microvascular arteriolar function (FIDart) did not differ (0.99 ± 1.43% vs. 1.1 ± 1.7%, p = 0.78). The arterio-venous ratio (AVR) was higher in the VAD group (0.90 ± 0.06 vs 0.85 ± 0.09, p = 0.01), reflecting wider retinal arteriolar and narrower venular diameters. There was no difference in vascular function between patients with CF-LVAD and pulsatile Bi-VAD.
In patients with advanced heart failure, VAD implantation was associated with better endothelial function at the level of large arteries, but not in the microcirculation.
相当一部分心力衰竭（HF）患者会进展到晚期，这与发病率和死亡率的大幅增加相关。这些患者可能适合采用先进的治疗策略，如使用心室辅助装置（VAD）进行机械循环支持。血管功能障碍是心力衰竭病理生理学和预后的一个标志。然而，VAD的血流动力学益处是否以及在何种程度上影响血管功能仍不清楚。
在本研究中，我们通过血流介导的血管舒张（FMD）和闪烁光诱导的视网膜血管舒张（FID）来评估内皮血管功能。将34例植入VAD的患者（年龄58±10岁，85%为男性，74%为缺血性心脏病，26例为连续流（CF）左心室辅助装置，8例为搏动性双心室（bi）VAD）与34例倾向匹配的晚期心力衰竭（AdvHF）患者（平均年龄62±9岁，68%为男性，59%为缺血性心脏病）进行比较。与匹配的AdvHF患者相比，VAD植入术后患者较大动脉的内皮功能（FMD）明显更好（7.2±4.6%对5.0±3.2%，p=0.03），而微血管小动脉功能（FIDart）没有差异（0.99±1.43%对1.1±1.7%，p=0.78）。VAD组的动静脉比（AVR）更高（0.90±0.06对0.85±0.09，p=0.01），反映出视网膜小动脉更宽，小静脉更窄。CF-LVAD患者和搏动性Bi-VAD患者之间的血管功能没有差异。
在晚期心力衰竭患者中，VAD植入与大动脉水平更好的内皮功能相关，但在微循环中并非如此。
