updateonarterialstiffness大動(dòng)脈僵硬研究進(jìn)展-展示頁(yè)
2024-09-13 14:25本頁(yè)面
【正文】 g 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。46:200204 血流 血流 Evaluation of arterial stiffness Surrogate Measures of arterial stiffness Pulse Wave Velocityamp。 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。由于衰老動(dòng)脈硬度不斷增加， PWV加快，反射波提前產(chǎn)生，落在中心動(dòng)脈壓力波的收縮期而而主動(dòng)脈 舒張期壓力下降 （下圖） 。 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。 PP in subjects 50 years of age, ventricular ejection tends to be reduced, so that arterial stiffness and amplitude and timing of wave reflections bee the main determinants of increased SBP and PP. Question: Is arterial stiffness a marker of cardiovascular disease and mortality in the elderly? PWV amp。Update on Arterial Stiffness 大動(dòng)脈僵硬研究進(jìn)展 中國(guó)醫(yī)學(xué)科學(xué)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 Left ventricle ejection, which taking blood into the aorta, generates a pressure wave that is propagated to other arteries throughout the body. Propagation occurs along the arterial wall Systole . Blood = inpressible fluid Artery = elastic conduit } Radial waveform Ascending aortic waveform Female 18 years Female 48 years Female 97 years O’Rourke amp。 Nichols. McDonald’s Blood Flow in Arteries. Arnold, L
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