Liu Jia, Chen Chang, Yu Zhongping, Chen Xuwei, Chen Zihao, Li Wei, Ye Min, He Xin, He Jiangui, Liu Juping, Dong Yugang, Staessen Jan A, Liu Chen, Yao Fengjuan, Wei Fang-Fei
Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China.
Department of Medical Ultrasonics, Institute for Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.
J Clin Hypertens (Greenwich). 2025 Jun;27(6):e70087. doi: 10.1111/jch.70087.
Deficiency of the myocardial microcirculation plays a role in the pathogenesis of heart failure (HF). We aimed to investigate the association of myocardial blood flow (MBF) and the retinal microvasculature with left ventricular (LV) function and its potential mediators. In healthy controls (HCs; n = 48), patients with cardiovascular risk factors (CVRF; n = 49) and patients with compensated HF (CHF; n = 52), we assessed LV diastolic filling pressure (E/e'), LV ejection fraction (LVEF), and global longitudinal strain (GLS) associated with MBF and the retinal arteriole-to-venule ratio (AVR), using multivariable regression models, while considering their direct contributions to LV function and the indirect contributions running via NT-proBNP. Compared with HC, CHF had lower MBF and smaller AVR (p ≤ 0.002). In all participants, smaller AVR was associated with higher E/e', lower LVEF, and lower GLS (p ≤ 0.010). Per 1 dB × dB/s MBF reduction, E/e' increased by 0.09, whereas LVEF and GLS decreased by 0.46% and 0.14%, respectively (p < 0.001). The indirect contributions running via NT-proBNP were all significant (p < 0.001) for MBF and for AVR related to GLS (p = 0.044) with mediation proportions of ≥29%. Across subgroups, these associations were directionally similar but lost significance given the lower sample size. Furthermore, across the spectrum of LV function, estimates of the associations of MBF with E/e' and AVR with GLS showed a decreasing versus increasing trend (p ≤ 0.034). MBF and retinal microvasculature were associated with LV function and counterbalance the impaired LV function in CHF. NT-proBNP, the natural vasodilating and natriuretic hormone, contributes close to 30% of the maintenance of LV function.
心肌微循环功能不全在心力衰竭（HF）的发病机制中起作用。我们旨在研究心肌血流（MBF）和视网膜微血管与左心室（LV）功能及其潜在介质之间的关联。在健康对照者（HCs；n = 48）、有心血管危险因素（CVRF）的患者（n = 49）和代偿性HF患者（CHF；n = 52）中，我们使用多变量回归模型评估与MBF和视网膜动静脉比（AVR）相关的左心室舒张充盈压（E/e'）、左心室射血分数（LVEF）和整体纵向应变（GLS），同时考虑它们对左心室功能的直接贡献以及通过N末端B型利钠肽原（NT-proBNP）产生的间接贡献。与HC相比，CHF的MBF较低且AVR较小（p≤0.002）。在所有参与者中，较小的AVR与较高的E/e'、较低的LVEF和较低的GLS相关（p≤0.010）。MBF每降低1 dB×dB/s，E/e'增加0.09，而LVEF和GLS分别降低0.46%和0.14%（p<0.001）。通过NT-proBNP产生的间接贡献对于MBF以及与GLS相关的AVR均具有显著性（p<0.001），中介比例≥29%。在各亚组中，这些关联在方向上相似，但由于样本量较小而失去显著性。此外，在左心室功能的整个范围内，MBF与E/e'以及AVR与GLS的关联估计呈现出下降与上升趋势（p≤0.034）。MBF和视网膜微血管与左心室功能相关，并在CHF中抵消受损的左心室功能。NT-proBNP，一种天然的血管舒张和利钠激素，对维持左心室功能的贡献接近30%。
