Abstract
There are cross-sectional and longitudinal imaging studies using echocardiography and cardiac magnetic resonance in healthy adult subjects which have demonstrated associations of left ventricular (LV) structure and pump function with age. There are also cross-sectional data regarding the relationships of age with invasively measured left heart chamber pressures. Increasing age is associated with decreases in LV end-diastolic volume (LVEDV), end-systolic volume (LVESV), end-diastolic length (LVEDL), stroke volume (SV) and cardiac output (CO), and increases in relative wall thickness (RWT), LV mass/LVEDV ratio (LVMVR) and ejection fraction (LVEF). Older age is not accompanied by a change in mean left atrial (LA) pressure, but there is both direct and indirect evidence which suggests that LV end-diastolic pressure (LVEDP) increases with age. LVEDV remains lower in older than younger subjects during fluid infusion and the resulting increases in LA pressure. The combination of an increase in LVEF with reductions of both SV and CO demonstrates an age-related increase in divergence between LVEF and LV pump function. A lower LVEDV in older compared to younger subjects can be characterized as an aging-related decrease in LV capacity, with the higher LVEDP in older subjects also indicating a reduction of preload reserve.
Highlights
It has been recognized for more than three decades that a substantial proportion, and possibly as many as 50%, of subjects with heart failure not due to valvular heart disease have a normal or near-normal (“preserved”) left ventricular (LV) ejection fraction (EF) [1,2,3,4]
There are well-described, but possibly under-appreciated, effects of aging on the left ventricle and the aim of this review is to provide a summary of: (1) the data from cross-sectional and longitudinal echocardiographic and cardiac magnetic resonance (CMR) studies which have measured aspects of LV structure and pump function in healthy adult subjects of varying ages, and of (2) the data from invasive studies which have investigated aging effects on left atrial (LA) pressure and LV enddiastolic pressure (LVEDP), and (3) to consider some of the pathophysiological implications of these findings
There are aging-related increases in wall thickness, relative wall thickness (RWT), the LV mass/LVEDV ratio (LVMVR) and LVEF, which occur in association with reductions in LV end-diastolic length (LVEDL), LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), stroke volume (SV) and cardiac output (CO)
Summary
It has been recognized for more than three decades that a substantial proportion, and possibly as many as 50%, of subjects with heart failure not due to valvular heart disease have a normal or near-normal (“preserved”) left ventricular (LV) ejection fraction (EF) [1,2,3,4]. Fukuda et al [30] studied 410 healthy Japanese subjects of age range 20–69 years (62% male) and with indexation to BSA, LVEDV, LVEDVi, LVESV and LVESVi all decreased with age and LVMVR increased with age in both sexes. In subjects without diabetes there were age-related increases in wall thickness and decreases in LVEDD, independent of sex, height, weight and BP. There are mostly consistent data from cross-sectional Mmode studies showing aging-related increases in LV wall thicknesses (with and without indexation) and increases in RWT, in both men and women. Cross sectional studies using 2-D or 3-D volume measurements have in most cases demonstrated aging-related reductions in LVEDV, LVESV and SV, with and without indexation, and in both men and women. There has only been one longitudinal echocardiography study and this reported increases in wall thickness and RWT, and decreases in both LVEDD and LVESD which were independent of body size
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