Rapid left ventricular filling is more dependent on age and twenty-four-hour blood pressure than on cardiac size
W B White1, P Schulman, H M Dey
1Section of Hypertension and Vascular Diseases, University of Connecticut Health Center, Farmington 06032.
Insights
Age and blood pressure significantly impact left ventricular filling. Beyond 53, age is the primary factor, diminishing filling rates irrespective of hypertension status.
Area of Science:
- Cardiology
- Gerontology
- Hypertension Research
Background:
- Diastolic dysfunction, characterized by impaired left ventricular filling, is a key concern in cardiovascular health.
- Understanding factors influencing diastolic function is crucial for managing conditions like hypertension and age-related cardiac changes.
Purpose of the Study:
- To investigate the relationship between age, 24-hour ambulatory blood pressure, and cardiac structural parameters with rapid left ventricular filling.
- To determine the relative importance of age, blood pressure, and cardiac structure on left ventricular filling rates.
Main Methods:
- Utilized 24-hour ambulatory blood pressure monitoring, M-mode echocardiography, and radionuclide ventriculography in 47 subjects (21 normotensive, 26 hypertensive).
- Performed univariate and multiple regression analyses incorporating age, blood pressure, ejection fraction, left atrial size, and left ventricular mass index.
Main Results:
- Left ventricular filling rate showed strong negative correlations with age and 24-hour systolic/diastolic blood pressure.
- Age was the most significant correlate; 88% of individuals over 53 exhibited reduced filling rates, independent of blood pressure.
- In individuals under 53, reduced filling rates were observed only in hypertensive subjects.
Conclusions:
- Left ventricular filling rate is predominantly influenced by age and 24-hour blood pressure, rather than left ventricular mass index.
- In individuals over 53, distinguishing the effects of hypertension from age-related diastolic alterations is challenging.
Abstract:
The associations of age, blood pressure and cardiac structure with rapid left ventricular filling were assessed in 47 subjects (21 normotensives and 26 age-matched untreated hypertensives) by 24-h ambulatory blood pressure monitoring, sector-guided M-mode echocardiography and radionuclide ventriculography. Univariate analyses revealed strong negative correlations of the left ventricular filling rate with age, and 24-h systolic and diastolic blood pressure, and a moderate positive correlation with the left ventricular ejection fraction at rest. Multiple regression analysis was performed with these variables, left atrial size and left ventricular mass index. Left atrial size and the left ventricular mass index were dependent on 24-h blood pressure, indicating that these two cardiac structural variables were less important than left ventricular filling. Age was undoubtedly the most important correlate of left ventricular filling, since 88% of the subjects over 53 years of age had reduced left ventricular filling rates regardless of the blood pressure status. However, under the age of 53 years, only the hypertensives had reduced filling rates. Thus, our study shows that the left ventricular filling rate is more dependent on age and 24-h blood pressure than on the left ventricular mass index. Furthermore, in patients over 53 years of age, it is not possible to separate the effects of hypertension on the diastolic function of the heart from the physiological alterations associated with ageing.
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