动脉僵硬和左室舒张功能障碍：从心踝血管指数的见解。

IF 2.6 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung Pub Date : 2026-07-01 Epub Date: 2026-02-11 DOI:10.1016/j.hrtlng.2026.102741

Tuan Hoang Nguyen MD, Takamitsu Nakamura MD, PhD, Takeo Horikoshi MD, PhD, Manabu Uematsu MD, PhD, Tsuyoshi Kobayashi MD, PhD, Toru Yoshizaki MD, PhD, Yosuke Watanabe MD, PhD, Kazuto Nakamura MD, PhD, Akira Sato MD, PhD

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引用次数: 0

摘要

背景：动脉僵硬是心血管疾病的一个因素，但其在左心室充盈压升高和保留射血分数（HFpEF）心力衰竭中的作用尚不完全清楚。目的：本研究旨在评价动脉僵硬度与舒张早期二尖瓣血流速度(E)与舒张早期二尖瓣环速度（E’）之比的关系，以及其与左室舒张功能障碍的关系。方法：本研究对335例接受心踝血管指数（CAVI）测量的射血分数≥50%的心血管疾病患者进行横断面分析。采用多变量logistic回归确定左室充注压力升高的独立相关因素，定义为E/ E ' >14。采用平滑样条分析评估CAVI、年龄和E/ E′升高之间的剂量-反应关系。采用中介分析评估CAVI、年龄和高血压对充盈压升高的直接和间接影响。结果：CAVI与E/ E ' bbb14独立相关(优势比（OR） 1.43；95%可信区间（CI）： 1.17-1.74, p< 0.001)和舒张功能不全（OR 1.25; 95% CI 1.03-1.52, p = 0.024）。CAVI增强了充填压力升高的风险分层（净重分类指数= 0.588,p < 0.001；综合判别改善= 0.035,p= 0.008）。平滑样条分析显示，在CAVI阈值9.275以上，E/ E ' bbb14风险呈近指数增长。介导分析显示，年龄对E/ E′升高的影响中，CAVI占18.7% （p = 0.006）。结论：由CAVI量化的动脉硬度独立增加左室充盈压力并介导年龄相关效应。

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Arterial stiffness and left ventricular diastolic dysfunction: insights from the cardio-ankle vascular index

Background

Arterial stiffness is a contributor to cardiovascular morbidity, but its role in elevated left ventricular (LV) filling pressure and heart failure with preserved ejection fraction (HFpEF) remains incompletely understood.

Objectives

This study aimed to evaluate the relationship between arterial stiffness and the ratio of early diastolic transmitral flow velocity (E) to early diastolic mitral annulus velocity (e'), as well as its association with LV diastolic dysfunction.

Methods

This study cross-sectionally analyzed 335 patients with cardiovascular disease and an ejection fraction ≥50% who underwent the Cardio-Ankle Vascular Index (CAVI) measurement. Multivariable logistic regression was used to identify independent associated factors of elevated LV filling pressure, defined as E/e' >14. Smoothing spline analysis was used to assess the dose-response relationship between CAVI, age, and elevated E/e'. Mediation analysis was used to assess the direct and indirect effects of CAVI, age, and hypertension on elevated filling pressure.

Results

CAVI was independently associated with E/e' >14 (odds ratio (OR) 1.43; 95% confidence interval (CI): 1.17–1.74, p < 0.001) and diastolic dysfunction (OR 1.25; 95% CI 1.03–1.52, p = 0.024). CAVI enhanced risk stratification for elevated filling pressure (net reclassification index = 0.588, p < 0.001; integrated discrimination improvement = 0.035, p = 0.008). Smoothing spline analysis revealed a near-exponential increase in E/e' >14 risk above a CAVI threshold of 9.275. Mediated analysis indicated that CAVI accounted for 18.7% of the effect of age on elevated E/e' (p = 0.006).

Conclusion

Arterial stiffness, as quantified by CAVI, independently increases the LV filling pressure and mediates age-related effects.

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来源期刊

Heart & Lung 医学-呼吸系统

CiteScore

4.60

自引率

3.60%

发文量

184

审稿时长

35 days

期刊介绍： Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders. The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.