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Left ventricular diastolic filling in the elderly: the cardiovascular health study
J M Gardin1, A M Arnold, D E Bild
1Department of Medicine, University of California, Irvine, USA.
Insights
Aging affects left ventricular diastolic function, with velocity changes observed in older adults. These changes are linked to cardiovascular conditions like hypertension and heart failure.
Area of Science:
- Cardiology
- Gerontology
- Medical Imaging
Background:
- Left ventricular (LV) diastolic function, assessed by transmitral flow velocity, changes with aging.
- Impaired LV diastolic function is crucial in elderly cardiovascular diseases such as hypertension, ischemic heart disease, and congestive heart failure (CHF).
Purpose of the Study:
- To investigate the relationship between aging, gender, blood pressure, and left ventricular diastolic function using Doppler echocardiography.
- To compare diastolic function parameters across different health status subgroups in the elderly.
Main Methods:
- Utilized echocardiography to assess transmitral flow velocities in a large cohort (n=5,201) of community-dwelling older adults (≥65 years) from the Cardiovascular Health Study.
- Employed multivariate analyses to examine associations between age, gender, heart rate, blood pressure, and diastolic function parameters.
- Compared Doppler transmitral velocities among healthy and clinical disease subgroups (CHF, hypertension).
Main Results:
- Early diastolic peak filling velocity decreased, and late diastolic (atrial) velocity increased with age (p <0.001).
- Women exhibited higher early and late diastolic peak velocities than men, even after adjusting for body size.
- Both early and late diastolic velocities correlated with blood pressure, increasing with systolic BP and decreasing with diastolic BP.
- CHF subgroup showed highest early diastolic velocities; CHF and hypertension subgroups had highest late diastolic velocities.
- Hypertension subgroup had the lowest early-to-late diastolic velocity ratio; men with CHF had the highest ratio.
Conclusions:
- Aging significantly alters left ventricular diastolic function, characterized by reduced early filling and increased atrial contribution.
- Gender and blood pressure are key determinants of diastolic transmitral velocities in older adults.
- Diastolic function patterns vary across clinical subgroups, reflecting distinct pathophysiological mechanisms in hypertension and CHF.
Abstract:
Changes in left ventricular (LV) diastolic function (e.g., as measured by transmitral flow velocity) are known to occur with aging. In addition, impaired LV diastolic function plays an important role in such cardiovascular disorders common in the elderly as hypertension, ischemic heart disease, and congestive heart failure (CHF). Participants in the Cardiovascular Health Study, a multicenter study of community-dwelling men (n=2,239) and women (n=2,962) > or = 65 years of age, underwent an extensive baseline evaluation, including echocardiography. Early diastolic LV Doppler (transmitral) peak filling velocity decreased, and peak late diastolic (atrial) velocity increased with age in multivariate analyses (all p <0.001). Early and late diastolic peak filling velocities were both significantly higher in women than in men, even after adjustment for body surface area (or height and weight). In multivariate models in the entire cohort and a healthy subgroup (n=703), gender, age, heart rate, and blood pressure (BP) were most strongly related to early and late diastolic transmitral peak velocities. Early and late diastolic peak velocities both increased with increases in systolic BP and decreased with increases in diastolic BP (p <0.001). Doppler transmitral velocities were compared among health status subgroups. In multiple regression models adjusted for other covariates, and in analysis of variance models examining differences across subgroups adjusted only for age, the subgroup with CHF had the highest early diastolic peak velocities. All clinical disease subgroups had higher late diastolic peak velocities than the healthy subgroup, with the subgroups with either CHF or hypertension having the highest age-adjusted means. The subgroup with hypertension had the lowest ratio of early-to-late diastolic peak velocity, and men with CHF had the highest ratio. These findings are consistent with previous reports that hypertensive subjects exhibit an abnormal relaxation pattern, whereas patients with CHF develop a pattern suggestive of an increased early diastolic left atrial-LV pressure gradient.