Saba P S, Roman M J, Pini R, Spitzer M, Ganau A, Devereux R B
Department of Medicine, New York Hospital-Cornell Medical Center, New York 10021.
J Am Coll Cardiol. 1993 Dec;22(7):1873-80. doi: 10.1016/0735-1097(93)90772-s.
The purpose of this study was to examine the relation of the central arterial pressure waveform to left ventricular and carotid structure.
The pressure waveform in the central arteries is affected by reflection of the pressure wave from the periphery. When reflected waves merge with the incident wave during systole, a late systolic peak and increment in systolic blood pressure are observed. The consequent increase in hemodynamic load may stimulate left ventricular and vascular adaptive changes.
Sixty-seven normotensive adults were studied by noninvasive techniques. Anatomy and function of the left ventricle and carotid artery were investigated by ultrasonography. Pressure waveforms were recorded by an external tonometer applied to the carotid artery, and waveform shape was expressed by the augmentation index, calculated from the difference between the maximal systolic pressure and that at the inflection between early and late systolic pressure peaks divided by the pulse pressure. Subjects were assigned to groups with a dominant early (group 1, augmentation index < or = 0) or dominant late systolic peak (group 2, augmentation index > 0).
Left ventricular mass index was significantly higher in group 2 than in group 1, a difference that persisted after controlling for the confounding effects of gender, age and blood pressure. Carotid wall thickness and regional arterial stiffness were significantly increased in group 2, but differences disappeared in the analysis of covariance for age.
Left ventricular and carotid artery structure are related to the shape of the central pressure waveform. Although the increase in left ventricular mass seen in subjects with a dominant late systolic peak pressure appears to be directly related to the shape of the pressure waveform, changes in the structural and physical properties of the carotid artery appear to be more closely related to the aging process.
本研究旨在探讨中心动脉压波形与左心室及颈动脉结构之间的关系。
中心动脉的压力波形受外周压力波反射的影响。当反射波在收缩期与入射波合并时，可观察到收缩晚期峰值和收缩压升高。由此导致的血流动力学负荷增加可能会刺激左心室和血管的适应性变化。
采用无创技术对67名血压正常的成年人进行研究。通过超声检查左心室和颈动脉的解剖结构及功能。使用置于颈动脉的外部血压计记录压力波形，波形形状用增强指数表示，增强指数由最大收缩压与收缩早期和晚期峰值之间拐点处的收缩压之差除以脉压计算得出。将受试者分为收缩早期峰值占主导的组（第1组，增强指数≤0）或收缩晚期峰值占主导的组（第2组，增强指数>0）。
第2组的左心室质量指数显著高于第1组，在控制了性别、年龄和血压的混杂效应后，这一差异仍然存在。第2组的颈动脉壁厚度和局部动脉僵硬度显著增加，但在年龄协方差分析中差异消失。
左心室和颈动脉结构与中心压力波形的形状有关。虽然收缩晚期峰值压力占主导的受试者中左心室质量增加似乎与压力波形的形状直接相关，但颈动脉结构和物理特性的变化似乎与衰老过程更为密切相关。
