科研之友
微信
新浪微博
Facebook
分享链接
摘要
Arterial stiffness is the major determinant of isolated systolic hypertension and increased pulse pressure. Aortic stiffness is also associated with increased cardiovascular morbidity and mortality in patients with chronic kidney disease, hypertension, and general population. Hemodynamically, arterial stiffness results in earlier aortic pulse wave reflection leading to increased cardiac workload and decreased myocardial perfusion. Although the clinical consequence of aortic stiffness has been clearly established, its pathophysiology in various clinical conditions still remains poorly understood. The aim of the present paper is to review the studies that have looked at the impact of dialysis calcium concentration on arterial stiffness. Overall, the results of small short-term studies suggest that higher dialysis calcium is associated with a transient but significant increase in arterial stiffness. This calcium dependant increase in arterial stiffness is potentially explained by increased vascular smooth muscle tone of the conduit arteries and is not solely explained by changes in mean blood pressure. However, the optimal DCa remains to be determined, and long term studies are required to evaluate its impact on the progression of arterial stiffness. 1. Introduction Midsize and large-size arteries are primarily responsible for carrying blood from the heart to the tissues (conductive function) and contribute little to the total vascular resistance. However, the arterial tree must also cope with the cyclic cardiac output and assure the perfusion of organs even during diastole. In this respect, aorta, with its unique elastic capacity, plays a vital role in dampening of the peak systolic pressure and uses its elastic recoil to assure blood flow to the organs even during diastole. Consequently, aortic stiffness, a major determinant of isolated systolic hypertension and increased pulse pressure, has been associated with increased cardiovascular events and mortality [1每5]. The mechanisms of arterial stiffness in various clinical conditions still remain poorly understood. It is thought that stiffness of central elastic arteries is the result of fragmentation of elastin fibers, increased extracellular matrix production of collagen (vascular fibrosis), modification of extracellular matrix by advances glycation end-products, and medial vascular calcification (Mˋnckeberg sclerosis) [6每10]. 2. Arterial Stiffness and Its Hemodynamic Consequences Arterial stiffness is best evaluated by determination of pulse wave velocity (PWV) over the arterial segment of interest
- 出版日期2011
