Abstract
Background and aims: Left ventricular (LV) function in the healthy aging heart is modified by biochemical changes with advancing age. We employed for the first time Tissue Doppler Imaging (TDI), to identify which phase of the cardiac cycle is involved. Methods: TDI was performed in 175 aging subjects, free of cardiovascular and/or respiratory disease (group II), and in 182 healthy adults enrolled as the control group (group I), to calculate the Myocardial Performance Index (MPI). The index derives from the values of Isovolumetric Contraction Time (ICT), Isovolumetric Relaxation Time (IRT) and Left Ventricular Ejection Time (LVET) measured in ms, according to the formula: (ICT+IRT)/LVET. Results: An increase in MPI in group II was shown, with significant lengthening of IRT in comparison with the same value obtained in the control group (group I), ICT and LVET were unchanged. Conclusions: The rise in IRT in the aging healthy heart is dependent on diastolic LV dysfunction consequent upon the formation of Advanced Glycosilation End-product (AGE) crosslinks with connectival proteins of interstitial myocardial tissue. Age-related increase in oxidative stress also modifies some interstitial compounds, favoring hardening of ventricular walls. These changes are similar to those happening in the diabetic heart, and TDI seems to be able to define non-invasively which phase of the cardiac cycle is impaired.
Similar content being viewed by others
References
Cacciapuoti F, Granata A, Minicucci F, Grassia A, Manduca A, Capasso A. Echocardiographic findings of some cardiac changes typical of the elderly. Cardiovasc Diagn Proc 1997; 14: 207–10.
Cacciapuoti F, Carbone L, Gentile S, Mirra G, Minicucci F. Haemodynamic changes of some cardiopulmonary parameters in aged subjects. Proceedings XIII World Congress of Gerontology 1997; p. 306.
Wei JY. Age and the cardiovascular system. N Engl J Med 1992; 327: 1735–9.
Tei C, Ling LH, Hodge DO et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function: a study in normal and dilated cardiomyopathy. J Cardiol 1995; 26: 357–66.
Tei C. New invasive index for combined systolic and diastolic ventricular function. J Cardiol 1995; 26: 135–6.
Sutherland GR, Steward MJ, Grounstroem KWE. Color Doppler myocardial imaging: a new technique for the assessment of myocardial function. J Am Soc Echocardiogr 1994; 7: 441–58.
Galiuto L, Ignone G, De Maria A. Contraction and relaxation velocities of the normal left ventricle using pulsed-wave tissue Doppler echocardiography. Am J Cardiol 1998; 81: 609–14.
Yamazaki N, Mine Y, Sano A, Hirama M, Miyatake K, Yamagishi M. Analysis of ventricular wall motion using color-coded tissue Doppler imaging system. Jpn J Appl Physiol 1994; 33: 3141–6.
Hori Y, Kunihiro S, Hoshi F, Higuchi S. Comparison of the myocardial performance index derived by use of pulsed Doppler echocardiography and tissue Doppler imaging in dogs with volume overload. Am J Vet Res 2007; 68: 1177–82.
American Diabetes Association: Standards of medical care in diabetes (Position Statement). Diabetes Care 2004; 27 (Suppl. 1): S15–35.
Shiller NB, Shah PM, Crawford M et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of two-dimensional Echocardiograms. J Am Soc Echocardiogr 1994; 2: 239–46.
Dagdelen S, Eren N, Karabulut H, Caglar N. Importance of the index of myocardial performance in evaluation of left ventricular function. Echocardiography 2002; 19: 273–8.
Szymanskj P, Rezler J, Stec S, Buda] A. Long-term prognostic value of an index of myocardial performance in patients with myocardial infarction. Clin Cardiol 2002; 25: 378–83.
Cacciapuoti F, Arciello A, Fiandra M, Manfredi E, Lama D, Cacciapuoti F. Index of myocardial performance after early phase of myocardial infarction in relation to its location. J Am Soc Echocardiogr 2004; 17: 345–9.
Lax JA, Bermann AM, Cianciulli TF, Morita LA, Masoli O, Prezioso HA. Estimation of the ejection fraction in patients with myocardial infarction obtained from the combined index of systolic and diastolic left ventricular function: a new method. J Am Soc Echocardiogr 2000; 13: 116–23.
Kang SM, Ha JW, Rim SJ, Chung N. Index of myocardial performance using Doppler-derived parameters in the evaluation of left ventricular function in patients with essential hypertension. Yonsei Med J 1998; 39: 446–52.
Bruch C, Schmermund DM, Katz M, Bartel T, Schaar J, Erbel R. Tei-index in patients with mild-to-moderate congestive heart failure. Eur Heart J 2000; 21: 1888–95.
Tei C, Dujardin KS, Hodge DO, Kjle RA, Tajik AJ, Seward JB. Doppler index combining systolic and diastolic myocardial performance: clinical value in cardiac amyloidosis. J Am Coll Cardiol 1996; 28: 658–64.
Kosmala W, Kucharski W, Przewlocka-Kosmala M, Mazurek W. Comparison of left ventricular function by Tissue Doppler Imaging in patients with diabetes mellitus without Systemic hypertension versus diabetes mellitus with systemic hypertension. Am J Cardiol 2004; 94: 395–9.
Mc Dickens WN, Sutherland GR, Gordon LN. Color Doppler velocity imaging of the myocardium. Ultrasound Med Biol 1992; 18: 651–4.
Miyatake K, Yamagishi M, Tanaka N, Uematsu M, Yamazaki N, Mine Y. New method for evaluating left ventricular wall motion by color-coded tissue Doppler imaging: in vitro and in vivo studies. J Am Coll Cardiol 1995; 25: 717–24.
Garcia MJ, Rodriguez L, Ares M, Griffin BP, Thomas JD, Klein AL. Differentiation of constrictive pericarditis from restrictive cardiomyopathy: assessment of left ventricular diastolic velocities in longitudinal axis by Doppler tissue imaging. J Am Coll Cardiol 1996; 27: 108–14.
Tekten T, Onbasili AO, Ceyhan C, Unal S, Discigil B. Novel approach to measure myocardial performance index: Pulsed-wave Tissue Doppler Echocardiography. Echocardiography 2003; 20: 503–10.
Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part I. Aging arteries: a “set up” for cardiovascular disease. Circulation 2003; 107: 139–46.
Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part II. The aging heart in health: links to heart disease. Circulation 2003; 107: 346–54.
Lakatta EG. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part III. Cellular and molecular clues to heart and arterial aging. Circulation 2003; 107: 490–7.
Spencer KT, Kirkpatrik JN, Mor-Avi V, Decara JM, Lang RM. Age dependency of the Tei index of myocardial performance. J Am Soc Echocardiogr 2004; 17: 350–2.
Oki T, Tabata T, Yamada H, Wakatsuki T, Shinohara H, Nishikado A. Clinical application of tissue Doppler imaging for assessing abnormal left ventricular relaxation. Am J Cardiol 1997; 79: 921–8.
Friedman EA. Advanced Glycosylated End Products and hyperglycemia in the pathogenesis of diabetic complications. Diabetes Care 1999; 22: (Suppl. 2): B65–71.
Preuss HG. Effects of glucose/insulin perturbations on aging chronic disorders: the evidence. J Am Clin Nutr 1997; 16: 397–403.
Fink RI, Koltermann OG, Griffin J, Olefsky JM. Mechanisms of insulin resistance in aging. J Clin Invest 1983; 71: 1523–35.
Vinereanu D, Nicolaides E, Tweddel AC et al. Subclinical left ventricular dysfunction in asymptomatic patients with type II diabetes mellitus related to serum lipids and glycated haemoglobin. Clin Sci (Lond) 2003; 105: 591–9.
Diamant M, Lamb HJ, Groeneveld Y et al. Diastolic dysfunction is associated with altered myocardial metabolism in asymptomatic normotensive patients with well controlled type II diabetes mellitus. J Am Coll Cardiol 2003; 42: 328–35.
Bradford R, Allen H. Oxidology. Chula Vista CA: R.W. Bradford Fundation 1997, 64–65.
Harman D. Free radical theory of aging: the free radical diseases. Age 7; 111–31, 1984.
Hodkinson AM, Pomerance A. The clinical significance of senile cardiac amyloidosis: a prospective clinico-pathological study. Q J Med 1977; 46: 381–7.
Kawamura S, Takahashi M, Ishihara T, Uchino F. Incidence and distribution of isolated atrial amyloid: histologic and immunohistochemical studies of 100 aging hearts. Pathol Int 1995; 45: 335–42.
Muscari C, Caldarera I, Rapezzi C, Branzi A, Caldarera CM. Biochemical correlates with myocardial aging. Cardioscience 1992; 3: 67–78.
Rodriguez L, Garcia M, Ares M, Griffin BP, Nakatani S, Thomas JD. Assessment of mitral annulus dynamics during diastole by Doppler tissue imaging: comparison with mitral Doppler inflow in subjects without heart disease and in patients with left ventricular hypertrophy. Am Heart J 1996; 131: 982–6.
Ohte N, Marita H, Kimura G. Evaluation of cardiac function using tissue doppler imaging. Med Rev 2000; 73: 30–5.
Li SY, Du M, Dolence EK et al. Aging induces cardiac diastolic dysfunction, oxidative stress, accumulation of advanced glycation end-products and protein modification. Aging Cell 2005; 4: 57–66.
Rojo EC, Rodrigo JL, Perez de Isla L et al. Disagreement between tissue Doppler imaging and conventional pulsed wave Doppler in the measurement of myocardial performance index. Eur J Echocardiogr 2006; 7: 356–64.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Cacciapuoti, F., Marfella, R., Paolisso, G. et al. Is the aging heart similar to the diabetic heart? Evaluation of LV function of the aging heart with Tissue Doppler Imaging. Aging Clin Exp Res 21, 22–26 (2009). https://doi.org/10.1007/BF03324894
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03324894