■最近的研究表明,在患有外周动脉疾病的患者中,射血分数保留的心力衰竭的患病率很高。我们假设血流限制性周围狭窄的血管内治疗(EVT)可改善左心室(LV)舒张功能。
30例根据心力衰竭协会保留的射血分数评分计划进行EVT或血管造影的有症状的外周动脉疾病和心力衰竭患者进行基线调查。EVT(n=25)或血管造影(对照,n=5),在4个月的随访中。外周血流动力学由总外周阻力决定,股动脉血流,踝臂指数.通过动脉顺应性测量主动脉功能,增强指数,和脉搏波速度。主动脉脉动负荷估计为近端主动脉的特性阻抗和波反射的幅度(反射系数)。左心室质量指数,LV平均壁厚,使用超声心动图评估收缩和舒张功能。以患者为中心的结果是跑步机步行距离和纽约心脏协会课程。
■EVT后,外周血流动力学随着总外周阻力的降低和总股动脉血流和踝肱指数的增加而显著改变.EVT后主动脉功能改善,增强指数和脉搏波速度显着降低,并且立即和随访时依从性增加,导致主动脉搏动负荷减少(近端主动脉的特性阻抗和反射系数)。同时,与对照组相比,EVT后左心室舒张功能改善,在后续行动中,室间隔和侧向e'速度增加,E/e'和左心房容积指数降低。随访时LV质量指数和LV平均壁厚下降。纽约心脏协会课程和跑步机步行距离在随访中改善了EVT后。增强指数,脉搏波速度,和动脉顺应性被确定为E/e'的独立贡献者。
■血流限制性髂股动脉狭窄的血管内治疗可降低主动脉搏动负荷,同时降低外周总阻力。这种有益效果与左心室舒张功能的急性和持续改善有关。
■URL:http://www。clinicaltrials.gov;唯一标识符:NCT02728479.
UNASSIGNED: Recent research indicates that there is a high prevalence of heart failure with preserved ejection fraction in patients with peripheral artery disease. We hypothesized that endovascular treatment (EVT) of flow-limiting peripheral stenosis improves left ventricular (LV) diastolic function.
UNASSIGNED: Thirty patients with symptomatic peripheral artery disease and heart failure with preserved ejection fraction according to Heart Failure Association-preserved ejection fraction score who were scheduled for EVT or angiography were investigated at baseline, the day after EVT (n=25) or angiography (control, n=5), and at 4 months follow-up. Peripheral hemodynamics were determined by the total peripheral resistance, common femoral artery flow, and ankle brachial index. Aortic function was measured by arterial compliance, augmentation index, and pulse wave velocity. Aortic pulsatile load was estimated as the characteristic impedance of the proximal aorta and the magnitude of wave reflection (reflection coefficient). LV mass index, LV mean wall thickness, and systolic and diastolic function were assessed using echocardiography. Patient-centered outcomes were treadmill walking distance and New York Heart Association class.
UNASSIGNED: After EVT, peripheral hemodynamics changed significantly with a decrease in total peripheral resistance and an increase in common femoral artery flow and ankle brachial index. Aortic function improved after EVT, with significantly reduced augmentation index and pulse wave velocity and increased compliance immediately and at follow-up, resulting in a reduction in aortic pulsatile load (characteristic impedance of the proximal aorta and reflection coefficient). Concurrently, LV diastolic function improved after EVT compared with control, acutely and at follow-up, with increased septal and lateral e´ velocities and decreased E/e´ and left atrial volume index. The LV mass index and LV mean wall thickness decreased at follow-up. The New York Heart Association class and treadmill walking distance improved post-EVT at follow-up. Augmentation index, pulse wave velocity, and arterial compliance were identified as independent contributors to E/e´.
UNASSIGNED: Endovascular treatment of flow-limiting iliofemoral stenosis reduces aortic pulsatile load and concurrently lowers total peripheral resistance. This beneficial effect is associated with an acute and sustained improvement of left ventricular diastolic function.
UNASSIGNED: URL: http://www.clinicaltrials.gov; Unique identifier: NCT02728479.