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Published on: July 25, 2019
Alteration of Cardiac Performance and Serum B-Type Natriuretic Peptide Level in Healthy Aging
Yuriko Yoshida1, Koki Nakanishi1, Masao Daimon2
1Department of Cardiovascular Medicine, University of Tokyo, Tokyo, Japan.
Insights
Aging impacts cardiac function, with left atrial strain decreasing earliest. Left atrial reservoir strain predicts elevated BNP, indicating potential heart failure risk in older adults.
Area of Science:
- Cardiology
- Gerontology
- Echocardiography
Background:
- Aging significantly impacts cardiac function, but subclinical changes remain under-investigated.
- Speckle-tracking echocardiography offers advanced methods to detect early cardiac dysfunction.
Purpose of the Study:
- To assess the effects of healthy aging on left ventricular, right ventricular, and left atrial performance.
- To explore the relationship between cardiac performance and serum B-type natriuretic peptide (BNP) levels in a healthy aging population.
Main Methods:
- Speckle-tracking echocardiography was used to measure left ventricular global longitudinal strain (LVGLS), right ventricular free wall strain, and left atrial (LA) phasic strain.
- 481 healthy participants underwent comprehensive cardiovascular examinations.
- Elevated BNP levels were defined based on the 90th percentile for sex-specific values.
Main Results:
- Left atrial reservoir and conduit strain showed the earliest age-related decline, starting around the 5th decade.
- Left ventricular global longitudinal strain (LVGLS) decreased from the 7th decade onwards.
- Age was an independent predictor of reduced LVGLS and LA strain; LA strain correlated with elevated BNP levels.
Conclusions:
- Reduced left atrial reservoir and conduit strain are early indicators of age-related cardiac remodeling.
- Left atrial reservoir strain is an independent predictor of elevated BNP, suggesting increased heart failure risk in older adults.
Background:
The impact of aging on cardiac function is not fully elucidated. Speckle-tracking echocardiography can unmask subclinical cardiac dysfunction.
Objectives:
This study investigated the impact of healthy aging on left ventricular (LV), right ventricular (RV), and left atrial (LA) performance and their relationship with serum B-type natriuretic peptide (BNP) levels in a sample of the general population without prevalent cardiovascular risk factors and structural heart disease.
Methods:
Speckle-tracking echocardiography was performed to assess LV global longitudinal strain (LVGLS), RV free wall strain, and LA phasic strain in 481 normal weight healthy participants who underwent extensive cardiovascular examination. Elevated BNP was defined as BNP >37.82 pg/ml for men and >50.86 pg/ml for women, which was the 90th percentile of BNP value distribution in the study population.
Results:
Mean age was 60 ± 12 years (range: 24 to 86 years), and 46% of the participants were men. The earliest alteration of age-related cardiac performance was observed in LA reservoir and conduit strain starting from decade 5, followed by elevated E/e' from decade 6. LVGLS decreased starting from decade 7, whereas there were no significant differences in RV strain, LV ejection fraction, or LV mass index across the decades. In the multivariable linear regression analyses, age was an independent predictor of decreased LVGLS (standardized β = 0.21; p < 0.001) and decreased LA phasic strain (standardized β = -0.40 and -0.61 for reservoir and conduit strain; both p < 0.001). Age and LA strain were significantly associated with elevated BNP values (adjusted odds ratios: 1.10 and 0.93; both p < 0.05, respectively), independent of ventricular morphology and function.
Conclusions:
Decreases in LA reservoir and conduit strain are the earliest markers of age-related cardiac remodeling, and LA reservoir strain is an independent predictor of elevated serum BNP level, with both possibly being markers of increased risk of heart failure in older adults.
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