Khder Y, el Ghawi R, Boscs L B, Aliot E, Zannad F
Hôpital Central, University Henri Poìncaré, Nancy, France.
Int J Cardiol. 1996 Oct 11;56(2):149-58. doi: 10.1016/0167-5273(96)02768-4.
The viscoelastic, muscular and endothelial components of the vessel wall may be altered in patients with congestive heart failure (CHF). In order to investigate the relative contribution of each of these components to the peripheral vascular mechanisms of the disease, we have studied post-ischemic (endothelial-dependent) and post-nitroglycerin (endothelial-independent) vasodilatation as well as the response to cold pressure test and the geometry and compliance of the radial artery using a non-invasive echotracking method coupled to digital photoplethysmography. Thirty-nine patients with congestive heart failure (ejection fraction = 28 +/- 2%) were compared to age- and sex-matched healthy controls. Baseline therapy was unchanged during the study. In congestive heart failure patients, cross-sectional compliance and volumic distensibility were greater (P < 0.05) but isobaric compliance which is independent of blood pressure value was unchanged. Post-ischemic and post-nitroglycerin vasodilatation were lower (7 +/- 1 vs. 11 +/- 1%, P < 0.01 and 6 +/- 1 vs. 14 +/- 2%, P < 0.001, respectively) and both of the arterial diameter and pressure responses to cold pressor test were blunted (-5 +/- 1 vs. -8 +/- 1%, P = 0.058 and 6 +/- 3 mmHg vs. 13 +/- 2 mmHg, P < 0.01, respectively) in congestive heart failure. These changes were similar in primary and ischemic congestive heart failure, suggesting that they are more likely related to common neuro-hormonal factors rather than to an atherosclerotic process.
充血性心力衰竭（CHF）患者血管壁的粘弹性、肌肉和内皮成分可能会发生改变。为了研究这些成分各自对该疾病外周血管机制的相对贡献，我们采用了一种与数字光电容积描记法相结合的无创回声跟踪方法，研究了缺血后（内皮依赖性）和硝酸甘油后（内皮非依赖性）血管舒张，以及对冷压试验的反应、桡动脉的几何形状和顺应性。将39例充血性心力衰竭患者（射血分数 = 28 ± 2%）与年龄和性别匹配的健康对照者进行比较。研究期间基线治疗不变。在充血性心力衰竭患者中，横截面顺应性和容积扩张性更大（P < 0.05），但与血压值无关的等压顺应性未改变。缺血后和硝酸甘油后血管舒张较低（分别为7 ± 1% 对11 ± 1%，P < 0.01和6 ± 1% 对14 ± 2%，P < 0.001），并且在充血性心力衰竭中，动脉直径和对冷加压试验的压力反应均减弱（分别为 -5 ± 1% 对 -8 ± 1%，P = 0.058和6 ± 3 mmHg对13 ± 2 mmHg，P < 0.01）。这些变化在原发性和缺血性充血性心力衰竭中相似，表明它们更可能与常见的神经激素因素有关，而不是与动脉粥样硬化过程有关。
