updateonarterialstiffness大動脈僵硬研究進展-全文預覽
【正文】 F O’Rourke?, LS Liu?, YQ Zhang?, XY He?, QC Cheng?, H Lou? ? Division of Hypertension, Fuwai Hospital amp。 177。 舒張壓變化 (mmHg) 177。 中心動脈 脈搏波通過已驗證的轉(zhuǎn)換函數(shù)從橈動脈脈搏波實時生成 。ARB ? Diuretics ? Spironolactone ? Agents acting on collagen crosslinking ? Vasopeptidase inhibitors The effect of nitroglycerin on wave reflection. From O’Rourke et al Quantification of glyceryl trinitrate effect through analysis of the synthesised ascending aortic pressure waveform ? X J Jiang1, M F O39。x10 4 ) 21 19 17 15 13 11 9 7 Pulse wave velocity (m/s) Nonobese Obese r = p BMI amp。 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。 提前 +主動脈的緩沖能力 ↓ 收縮壓 ↑ 冠狀動脈灌注 ↓ 左室后負荷 ↑ 左室肥厚 ↑ 冠狀動脈缺血 amp。 PROBABILITIES OF OVERALL AND EVENTFREE SURVIVAL IN HEMODIALYSIS PATIENTS 0 35 70 105 140 1 0 Duration of Follow up (month) 0 35 70 105 140 1 0 Duration of Follow up (month) PWV m/s PWV m/s PWV m/s PWV m/s Probability of overall survival Probability of eventfree survival (cardiovascular events) Blacher et al., Circulation 1999。Update on Arterial Stiffness 大動脈僵硬研究進展 中國醫(yī)學科學院 阜外心血管病醫(yī)院 高血壓診治中心 蔣 雄 京 Definition of Blood Pressure ? In clinical practice, blood pressure is defined in terms of systolic and diastolic blood pressure, which represent the extremes of the blood pressure oscillation around a mean value, the MBP. In fact, the blood pressure curve may be considered as the summation of a steady ponent, MBP, and a pulsatile ponent, the pulse pressure (PP). From: O’ Rourke PULSE WAVE Principles
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