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Atrial kinetics and left ventricular diastolic filling in the healthy elderly
Insights
Elderly individuals show delayed early diastolic filling and increased atrial contribution, indicating an adaptive response to reduced left ventricular compliance. This study clarifies diastolic function in healthy aging.
Area of Science:
- Cardiology
- Gerontology
- Physiology
Background:
- Diastolic dysfunction in the elderly is often linked to delayed relaxation and decreased myocardial compliance.
- Previous research on diastolic function has not consistently excluded coronary artery disease or accounted for atrial contraction's role.
Purpose of the Study:
- To evaluate radionuclide-derived diastolic variables in healthy elderly volunteers.
- To compare diastolic function between healthy elderly and young individuals.
- To investigate the adaptive mechanisms in the elderly's diastolic function.
Main Methods:
- Studied 13 healthy elderly (75 +/- 6 years) and 10 healthy young (26 +/- 5 years) volunteers.
- Utilized high-count, 32-frame gated blood pool imaging at rest.
- Analyzed left ventricular time-activity curves and constructed flow-volume loops.
Main Results:
- Elderly subjects exhibited decreased peak early diastolic filling rates and delayed filling times.
- Peak late left ventricular filling rates and the contribution of atrial filling volume were augmented in the elderly.
- These findings suggest an adaptive atrial response to reduced left ventricular compliance.
Conclusions:
- Healthy aging involves specific changes in left ventricular diastolic function, including delayed relaxation and altered filling patterns.
- The elderly heart demonstrates compensatory mechanisms, such as increased atrial contribution, to maintain diastolic filling.
- Radionuclide ventriculography is effective in characterizing age-related changes in diastolic function.
Abstract:
A delay of left ventricular isovolumic relaxation and decrease in myocardial compliance may result in a decline of measured early filling rates in elderly subjects. Previous studies of diastolic function, however, have not excluded coronary artery disease or addressed the contribution of atrial contraction to diastole. The present study evaluated radionuclide-derived diastolic variables in 13 healthy elderly volunteers aged 75 +/- 6 years without symptoms or risk factors for coronary disease who had normal findings on the stress electrocardiogram, stress gated blood pool imaging and two-dimensional echocardiogram. Results were compared with those of a group of 10 healthy young volunteers aged 26 +/- 5 years. High count, 32 frame, double-buffered gated blood pool acquisitions were obtained at rest in the left anterior oblique view with an RR interval variation less than 5%. Left ventricular time-activity curves were analyzed and flow-volume loops for each group were constructed. In the healthy elderly: peak early diastolic filling rate is decreased, time of peak early filling and time to first third of diastolic filling are delayed, and peak late left ventricular filling rate and percent of atrial filling volume are augmented, suggesting an adaptive response of the atria to diminished left ventricular compliance.