updateonarterialstiffness大動(dòng)脈僵硬研究進(jìn)展-文庫(kù)吧
2025-07-29 14:25 本頁(yè)面
【正文】 otheliummediated vasodilation, ? in matrix position of small arteries and arterioles, ? mediated alterations of vasomotor tone, arising from smooth muscle or endothelial cells. 動(dòng)脈硬度與心血管危險(xiǎn) 動(dòng)脈硬度 ↑ 反射波強(qiáng)度 ↑ amp。 提前 +主動(dòng)脈的緩沖能力 ↓ 收縮壓 ↑ 冠狀動(dòng)脈灌注 ↓ 左室后負(fù)荷 ↑ 左室肥厚 ↑ 冠狀動(dòng)脈缺血 amp。 心力衰竭 舒張壓 ↓ 脈壓 ↑ 搏動(dòng)性壓力和流量 ↑ 腦與腎 的微循環(huán)損害 ↑ 0 0 動(dòng)脈硬化如何改變大腦與腎的循環(huán)？ 腦、腎 其它器官 ?引自 O’Rourke MF, Safar ME. Hypertension 2020。46:200204 血流 血流 Evaluation of arterial stiffness Surrogate Measures of arterial stiffness Pulse Wave Velocityamp。Pulse Wave Analysis A simple method to assess arterial stiffness and distensibility. Widely used. Noninvasive and reproducible. Simultaneous assessment shows modest correlation (r=). Yasmin Brown MJ. QJM. 1999。 92: 595–600. Arterial pulse and pulse wave velocity(PWV) PWV=Distance/Pulse transit time Augmentation Index(AI)=Δp/pp AI is a time domain estimater of the contribution of the reflections relative to the pulse pressure Applanation tonometry Pressure Recording Pulse wave from SphygmoCor Central aortic pressure waveforms can be calculated from the radial artery pressure waveform using a generalized transfer function Other Surrogate Measures of stiffness ?Ambulatory Arterial Stiffness Index (AASI) ?Carotid or Aortic P/D relationship ?Aortic characteristic impedance Remain to investigate further Other methods for measuring arterial stiffness 1. Ultrasound technique 2. MRI 3. Catheterization Which are plex and expensive Question SBP, PP, PWV and AI, which is the best and practical predictor for CV risk? Some key questions to ask before using biomarkers PW V AIx ASP APP A m p l Stan d ardis ed √ √ √ √ √ Rep rod u cib le, acc u rate, av ailab le √ √ √ √ √ Po p u latio n s √ √ √ √ √ Ab n o r m al levels √ √ √ √ √ Co rr elatio n with ri sk f acto rs √ √ √ √ No v el m echan is m s √ √ √ √ √ Predictiv e of ou tco m e √ √ √ √ √ Res id u al con f o u n d in g ex clu d ed √ √ √ √ √ Incre m en tal utilit y , better √ √ √ √ √ I m p rov e testin g √ √ √ √ √ Ad d to ex istin g r isk p redictio n √ √ √ √ √ Deter m in e ther ap eu tic co u rse √ ? √ √ √ √ Ch an g e clinical practice √ √ √ √ √ Co st ef f ectiv e √ √ √ √ √ Circulation 2020。 113:233562 Reduction in LV mass with therapy in 2 years Parameters β = β = Aortic AIx 28 37 PP amplification 41 53 Radial AIx 45 59 Aortic augmented pressure 70 93 Aortic SBP 270 360 Brachial DBP 543 726 Brachial SBP 966 1294 Number of subjects required with α (twosided) = Hashimoto J, O’Rourke MF et al. Presented at AHA HBPR Council 2020, San Antonio, TX Effects of physiological phenomena on the arterial stiffness ? Aging: the dominant process altering vascular stiffness, ? wave reflections, and PP ? Physical fitness ? Heart rate ? Blood pressure ? Geic background: a potential factor of importance The change of blood pressure with age in China BPsruvey in 1990 (n=950,000)6070809010011012013014015015 20 25 30 35 40 45 50 55 60 65 70 75 80Age(yr)BP(mmHg)menwomenbothThe change of PP with age in China BP Survey in 1990 (n=95
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