MRI and echocardiographic assessment of the diastolic dysfunction of normal aging: Altered LV pressure decline or load?

Paul Hees, Jerome L. Fleg, Sheng Jing Dong, Edward Shapiro

Research output: Contribution to journalArticle

Abstract

Changes in diastolic indexes during normal aging, including reduced early filling velocity (E), lengthened E deceleration time (DT), augmented late filling (A), and prolonged isovolumic relaxation time (IVRT), have been attributed to slower left ventricular (LV) pressure (LVP) decay. Indeed, this constellation of findings is often referred to as the "abnormal relaxation" pattern. However, LV filling is determined by the atrioventricular pressure gradient, which depends on both LVP decline and left atrial (LA) pressure (LAP). To assess the relative influence of LVP decline and LAP, we studied 122 normal subjects aged 21-92 yr by Doppler echocardiography and MRI. LVP decline was assessed by color M-mode (Vp) and the LV untwisting rate. Early diastolic LAP was evaluated using pulmonary vein flow systolic fraction, pulmonary vein flow diastolic DT, color M-mode (E/V p), and tissue Doppler (E/Em). Linear regression showed the expected reduction of E, increase in A, and prolongation of IVRT and DT with advancing age. There was no relation of age to parameters reflecting the rate of LVP decline. However, older age was associated with reduced E/V p (P = 0.008) and increased pulmonary vein systolic fraction (P <0.001), pulmonary vein DT (P = 0.0026), and E/Em (P <0.0001), all suggesting reduced early LAP. Therefore, reduced early filling in older adults may be more closely related to a reduced early diastolic LAP than to slower LVP decline. This effect also explains the prolonged IVRT. We postulate that changes in LA active or passive properties may contribute to development of the abnormal relaxation pattern during the aging process.

Original languageEnglish (US)
JournalAmerican Journal of Physiology - Heart and Circulatory Physiology
Volume286
Issue number2 55-2
StatePublished - Feb 2004

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Ventricular Pressure
Pressure
Deceleration
Pulmonary Veins
Color
Blood Pressure
Atrial Pressure
Doppler Echocardiography
Linear Models

Keywords

  • Left atrial pressure
  • Left ventricular deformation
  • Noninvasive imaging
  • Torsion
  • Untwist

ASJC Scopus subject areas

  • Physiology

Cite this

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title = "MRI and echocardiographic assessment of the diastolic dysfunction of normal aging: Altered LV pressure decline or load?",
abstract = "Changes in diastolic indexes during normal aging, including reduced early filling velocity (E), lengthened E deceleration time (DT), augmented late filling (A), and prolonged isovolumic relaxation time (IVRT), have been attributed to slower left ventricular (LV) pressure (LVP) decay. Indeed, this constellation of findings is often referred to as the {"}abnormal relaxation{"} pattern. However, LV filling is determined by the atrioventricular pressure gradient, which depends on both LVP decline and left atrial (LA) pressure (LAP). To assess the relative influence of LVP decline and LAP, we studied 122 normal subjects aged 21-92 yr by Doppler echocardiography and MRI. LVP decline was assessed by color M-mode (Vp) and the LV untwisting rate. Early diastolic LAP was evaluated using pulmonary vein flow systolic fraction, pulmonary vein flow diastolic DT, color M-mode (E/V p), and tissue Doppler (E/Em). Linear regression showed the expected reduction of E, increase in A, and prolongation of IVRT and DT with advancing age. There was no relation of age to parameters reflecting the rate of LVP decline. However, older age was associated with reduced E/V p (P = 0.008) and increased pulmonary vein systolic fraction (P <0.001), pulmonary vein DT (P = 0.0026), and E/Em (P <0.0001), all suggesting reduced early LAP. Therefore, reduced early filling in older adults may be more closely related to a reduced early diastolic LAP than to slower LVP decline. This effect also explains the prolonged IVRT. We postulate that changes in LA active or passive properties may contribute to development of the abnormal relaxation pattern during the aging process.",
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author = "Paul Hees and Fleg, {Jerome L.} and Dong, {Sheng Jing} and Edward Shapiro",
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T1 - MRI and echocardiographic assessment of the diastolic dysfunction of normal aging

T2 - Altered LV pressure decline or load?

AU - Hees, Paul

AU - Fleg, Jerome L.

AU - Dong, Sheng Jing

AU - Shapiro, Edward

PY - 2004/2

Y1 - 2004/2

N2 - Changes in diastolic indexes during normal aging, including reduced early filling velocity (E), lengthened E deceleration time (DT), augmented late filling (A), and prolonged isovolumic relaxation time (IVRT), have been attributed to slower left ventricular (LV) pressure (LVP) decay. Indeed, this constellation of findings is often referred to as the "abnormal relaxation" pattern. However, LV filling is determined by the atrioventricular pressure gradient, which depends on both LVP decline and left atrial (LA) pressure (LAP). To assess the relative influence of LVP decline and LAP, we studied 122 normal subjects aged 21-92 yr by Doppler echocardiography and MRI. LVP decline was assessed by color M-mode (Vp) and the LV untwisting rate. Early diastolic LAP was evaluated using pulmonary vein flow systolic fraction, pulmonary vein flow diastolic DT, color M-mode (E/V p), and tissue Doppler (E/Em). Linear regression showed the expected reduction of E, increase in A, and prolongation of IVRT and DT with advancing age. There was no relation of age to parameters reflecting the rate of LVP decline. However, older age was associated with reduced E/V p (P = 0.008) and increased pulmonary vein systolic fraction (P <0.001), pulmonary vein DT (P = 0.0026), and E/Em (P <0.0001), all suggesting reduced early LAP. Therefore, reduced early filling in older adults may be more closely related to a reduced early diastolic LAP than to slower LVP decline. This effect also explains the prolonged IVRT. We postulate that changes in LA active or passive properties may contribute to development of the abnormal relaxation pattern during the aging process.

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