Advertisement

Age related structural and functional changes in left ventricular performance in healthy subjects: a 2D echocardiographic study

Abstract

Left ventricular (LV) adaptation to aging is currently poorly understood. We aimed to characterize age related changes in LV structure and function by studying a large group of healthy subjects across a wide age range. Prospectively enrolled healthy volunteers (n = 778, 327 females; age 18 to 100 years, mean age 49.8 ± 18.1 years), were divided into 4 age groups: 18 to 34 years (n = 165); 35 to 49 years (n = 242), 50 to 79 years (n = 334) and ≥ 80 years (n = 40). All subjects underwent clinical examination, as well as comprehensive transthoracic echocardiogram [TTE]. Body mass index, systolic blood pressure (BP), and left atrial volume (p < 0.0001) increased with age while diastolic BP (p < 0.0001) decreased over time. LV mass/body surface area (BSA) and relative wall thickness increased with age (p < 0.0001) coincident with worsening parameters of diastolic function (E/A and E/Em, p < 0.0001). The ejection fraction and Sm did not change significantly. Stroke volume, ejection time index, flow rate and stroke work significantly increased with age (p < 0.01). The arterial elastance (Ea), a measure of ventricular afterload, and ventricular elastance (Ees), an index of LV systolic stiffness did not change with age nor did their ratio (Ees/Ea) the latter being an expression of ventricular-arterial coupling. Age, gender and LVM were the main independent variables associated with LV systolic function. In conclusion, LV adaptation to aging in a healthy cohort is characterized by concentric LV remodeling, increased contractility and preserved ventricular-arterial coupling.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

Fig. 1

References

  1. 1.

    Betik AC, Hepple RT (2008) Determinants of VO2 max decline with aging: an integrated perspective. Appl Physiol Nutr Metab 33(1):130–140

  2. 2.

    Strait JB, Lakatta EG (2012) Aging-associated cardiovascular changes and their relationship to heart failure. Heart Fail Clin 8(1):143–164

  3. 3.

    Arbab-Zadeh A, Dijk E, Prasad A, Fu Q, Torres P, Zhang R et al (2004) Effect of aging and physical activity on left ventricular compliance. Circulation 110(13):1799–1805

  4. 4.

    Mor-Avi V, Spencer K, Gorcsan J, Demaria A, Kimball T, Monaghan M et al (2000) Normal values of regional left ventricular endocardial motion: multicenter color kinesis study. Am J Physiol Heart Circ Physiol 279(5):H2464–H2476

  5. 5.

    Diks SH, Parikh K, van der Sijde M, Joore J, Ritsema T, Peppelenbosch MP (2007) Evidence for a minimal eukaryotic phosphoproteome? PLoS ONE 2(8):e777

  6. 6.

    Ruan Q, Nagueh SF (2005) Effect of age on left ventricular systolic function in humans: a study of systolic isovolumic acceleration rate. Exp Physiol. 90(4):527–534

  7. 7.

    Spencer KT, Kirkpatrick JN, Mor-Avi V, Decara JM, Lang RM (2004) Age dependency of the Tei index of myocardial performance. J Am Soc Echocardiogr 17(4):350–352

  8. 8.

    Vriz O, Aboyans V, Minisini R, Magne J, Bertin N, Pirisi M et al (2017) Reference values of one-point carotid stiffness parameters determined by carotid echo-tracking and brachial pulse pressure in a large population of healthy subjects. Hypertens Res 40(7):685–695

  9. 9.

    Vriz O, Zito C, di Bello V, La Carrubba S, Driussi C, Carerj S et al (2016) Non-invasive one-point carotid wave intensity in a large group of healthy subjects: a ventricular-arterial coupling parameter. Heart Vessels 31(3):360–369

  10. 10.

    Angeli F, Reboldi G, Verdecchia P (2015) The 2014 hypertension guidelines: implications for patients and practitioners in Asia. Heart Asia 7(2):21–25

  11. 11.

    James PA, Oparil S, Carter BL, Cushman WC, Dennison-Himmelfarb C, Handler J et al (2014) 2014 evidence-based guideline for the management of high blood pressure in adults: report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA 311(5):507–520

  12. 12.

    Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16(3):233–270

  13. 13.

    Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP (1990) Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 322(22):1561–1566

  14. 14.

    Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA et al (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22(2):107–133

  15. 15.

    Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, et al. Clinical utility of doppler echocardiography and tissue doppler imaging in the estimation of left ventricular filling pressures. 2000.

  16. 16.

    Weissler AM, Harris LC, White GD (1963) Left ventricular ejection time index in man. J Appl Physiol 18:919–923

  17. 17.

    Saeed S, Senior R, Chahal NS, Lonnebakken MT, Chambers JB, Bahlmann E et al (2017) Lower transaortic flow rate is associated with increased mortality in aortic valve stenosis. JACC Cardiovasc Imaging 10(8):912–920

  18. 18.

    Grossman W (2000) Evaluation of systolic and diastolic function of the ventricles and myocardium. Grossman's Card Catheter Angiogr Interv 2000:367–390

  19. 19.

    Kelly RP, Ting CT, Yang TM, Liu CP, Maughan WL, Chang MS et al (1992) Effective arterial elastance as index of arterial vascular load in humans. Circulation 86(2):513–521

  20. 20.

    Chen CH, Fetics B, Nevo E, Rochitte CE, Chiou KR, Ding PA et al (2001) Noninvasive single-beat determination of left ventricular end-systolic elastance in humans. J Am Coll Cardiol 38(7):2028–2034

  21. 21.

    Briand M, Dumesnil JG, Kadem L, Tongue AG, Rieu R, Garcia D et al (2005) Reduced systemic arterial compliance impacts significantly on left ventricular afterload and function in aortic stenosis: implications for diagnosis and treatment. J Am Coll Cardiol 46(2):291–298

  22. 22.

    Lakatta EG (2002) Age-associated cardiovascular changes in health: impact on cardiovascular disease in older persons. Heart Fail Rev 7(1):29–49

  23. 23.

    Innelli P, Sanchez R, Marra F, Esposito R, Galderisi M (2008) The impact of aging on left ventricular longitudinal function in healthy subjects: a pulsed tissue Doppler study. Eur J Echocardiogr 9(2):241–249

  24. 24.

    Prasad A, Popovic ZB, Arbab-Zadeh A, Fu Q, Palmer D, Dijk E et al (2007) The effects of aging and physical activity on Doppler measures of diastolic function. Am J Cardiol 99(12):1629–1636

  25. 25.

    Gerstenblith G, Frederiksen J, Yin FC, Fortuin NJ, Lakatta EG, Weisfeldt ML (1977) Echocardiographic assessment of a normal adult aging population. Circulation 56(2):273–278

  26. 26.

    Cheng S, Fernandes VR, Bluemke DA, McClelland RL, Kronmal RA, Lima JA (2009) Age-related left ventricular remodeling and associated risk for cardiovascular outcomes: the multi-ethnic study of atherosclerosis. Circ Cardiovasc Imaging 2(3):191–198

  27. 27.

    Sonaglioni A, Baravelli M, Lombardo M, Sommese C, Anza C, Kirk JA et al (2018) Ventricular-arterial coupling in centenarians without cardiovascular diseases. Aging Clin Exp Res 30(4):367–373

  28. 28.

    Fujimoto N, Hastings JL, Bhella PS, Shibata S, Gandhi NK, Carrick-Ranson G et al (2012) Effect of ageing on left ventricular compliance and distensibility in healthy sedentary humans. J Physiol 590(8):1871–1880

  29. 29.

    Parikh JD, Hollingsworth KG, Wallace D, Blamire AM, MacGowan GA (2016) Normal age-related changes in left ventricular function: role of afterload and subendocardial dysfunction. Int J Cardiol 223:306–312

  30. 30.

    Meng R, Hollander C, Liebson PR, Teran JC, Barresi V, Lurie M (1975) The use of noninvasive methods in the evaluation of left ventricular performance in coronary artery disease I Relation of systolic time intervals to angiographic assessment of coronary artery disease severity. Am Heart J 90(2):134–144

  31. 31.

    De Caprio L, Rengo F, Spampinato N, Carlomagno A, Chiariello L, Spinelli L et al (1980) Left ventricular function after coronary artery bypass Non-invasive study by systolic time intervals. Acta Cardiol 35(2):93–105

  32. 32.

    Stack RS, Lee CC, Reddy BP, Taylor ML, Weissler AM (1976) Left ventricular performance in coronary artery disease evaluated with systolic time intervals and echocardiography. Am J Cardiol 37(3):331–339

  33. 33.

    Haiden A, Eber B, Weber T (2014) U-shaped relationship of left ventricular ejection time index and all-cause mortality. Am J Hypertens 27(5):702–709

  34. 34.

    Reant P, Dijos M, Donal E, Mignot A, Ritter P, Bordachar P et al (2010) Systolic time intervals as simple echocardiographic parameters of left ventricular systolic performance: correlation with ejection fraction and longitudinal two-dimensional strain. Eur J Echocardiogr 11(10):834–844

  35. 35.

    Migrino RQ, Mareedu RK, Eastwood D, Bowers M, Harmann L, Hari P (2009) Left ventricular ejection time on echocardiography predicts long-term mortality in light chain amyloidosis. J Am Soc Echocardiogr 22(12):1396–1402

  36. 36.

    Blais C, Burwash IG, Mundigler G, Dumesnil JG, Loho N, Rader F et al (2006) Projected valve area at normal flow rate improves the assessment of stenosis severity in patients with low-flow, low-gradient aortic stenosis: the multicenter TOPAS (truly or pseudo-severe aortic stenosis) study. Circulation 113(5):711–721

  37. 37.

    Voelker W, Reul H, Nienhaus G, Stelzer T, Schmitz B, Steegers A et al (1995) Comparison of valvular resistance, stroke work loss, and Gorlin valve area for quantification of aortic stenosis An in vitro study in a pulsatile aortic flow model. Circulation 91(4):1196–1204

  38. 38.

    Borges MC, Colombo RC, Goncalves JG, Ferreira Jde O, Franchini KG (2006) Longitudinal mitral annulus velocities are reduced in hypertensive subjects with or without left ventricle hypertrophy. Hypertension 47(5):854–860

  39. 39.

    Kass DA (2005) Ventricular arterial stiffening: integrating the pathophysiology. Hypertension 46(1):185–193

  40. 40.

    Redfield MM, Jacobsen SJ, Borlaug BA, Rodeheffer RJ, Kass DA (2005) Age- and gender-related ventricular-vascular stiffening: a community-based study. Circulation 112(15):2254–2262

  41. 41.

    Antonini-Canterin F, Poli S, Vriz O, Pavan D, Bello VD, Nicolosi GL (2013) The ventricular-arterial coupling: from basic pathophysiology to clinical application in the echocardiography laboratory. J Cardiovasc Echogr. 23(4):91–95

  42. 42.

    Borlaug BA, Lam CS, Roger VL, Rodeheffer RJ, Redfield MM (2009) Contractility and ventricular systolic stiffening in hypertensive heart disease insights into the pathogenesis of heart failure with preserved ejection fraction. J Am Coll Cardiol 54(5):410–418

  43. 43.

    Lam CS, Shah AM, Borlaug BA, Cheng S, Verma A, Izzo J et al (2013) Effect of antihypertensive therapy on ventricular-arterial mechanics, coupling, and efficiency. Eur Heart J 34(9):676–683

  44. 44.

    Osranek M, Eisenach JH, Khandheria BK, Chandrasekaran K, Seward JB, Belohlavek M (2008) Arterioventricular coupling and ventricular efficiency after antihypertensive therapy: a noninvasive prospective study. Hypertension 51(2):275–281

  45. 45.

    Guarracino F, Ferro B, Baldassarri R, Bertini P, Forfori F, Giannini C et al (2013) Non invasive evaluation of cardiomechanics in patients undergoing MitrClip procedure. Cardiovasc Ultrasound 11:13

  46. 46.

    Antonini-Canterin F, Enache R, Popescu BA, Popescu AC, Ginghina C, Leiballi E et al (2009) Prognostic value of ventricular-arterial coupling and B-type natriuretic peptide in patients after myocardial infarction: a five-year follow-up study. J Am Soc Echocardiogr 22(11):1239–1245

  47. 47.

    Chen CH, Nakayama M, Nevo E, Fetics BJ, Maughan WL, Kass DA (1998) Coupled systolic-ventricular and vascular stiffening with age: implications for pressure regulation and cardiac reserve in the elderly. J Am Coll Cardiol 32(5):1221–1227

  48. 48.

    Palatini P, Bongiovi S, Mario L, Schiraldi C, Mos L, Pessina AC (1995) Above-normal left ventricular systolic performance during exercise in young subjects with mild hypertension. Eur Heart J 16(2):232–242

  49. 49.

    Vermeersch SJ, Rietzschel ER, De Buyzere ML, De Bacquer D, De Backer G, Van Bortel LM et al (2008) Age and gender related patterns in carotid-femoral PWV and carotid and femoral stiffness in a large healthy, middle-aged population. J Hypertens 26(7):1411–1419

  50. 50.

    Gori M, Lam CS, Gupta DK, Santos AB, Cheng S, Shah AM et al (2014) Sex-specific cardiovascular structure and function in heart failure with preserved ejection fraction. Eur J Heart Fail 16(5):535–542

Download references

Acknowledgements

This study was partially fund by the AGING PROJECT—Department of Excellence—Università del Piemonte Orientale, Novara, Italy

Author information

Correspondence to Olga Vriz.

Ethics declarations

Conflict of interest

None of the authors had any personal or financial conflict of interest. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Vriz, O., Pirisi, M., Habib, E. et al. Age related structural and functional changes in left ventricular performance in healthy subjects: a 2D echocardiographic study. Int J Cardiovasc Imaging 35, 2037–2047 (2019). https://doi.org/10.1007/s10554-019-01665-y

Download citation

Keywords

  • Left ventricular function
  • Aging
  • Echocardiography