Abstract
BackgroundThe transmitral E wave and the peak velocity of early diastolic mitral annular motion (e`) both decrease with age, but the mechanisms underlying these age-related changes are incompletely understood. This study investigated the possible contributions of blood pressure (BP) and left ventricular end-diastolic length (LVEDL) to age-related reductions in E and e`.MethodsThe study group were 82 healthy adult subjects <55 years of age who were not obese or hypertensive. Transmitral flow and mitral annular motion were recorded using pulsed-wave Doppler. LVEDL was measured from the mitral annular plane to the apical endocardium.ResultsAge was positively correlated with diastolic BP and septal wall thickness (SWT), inversely correlated with LVEDL (β = -0.25) after adjustment for sex and body surface area, but was not related to left ventricular end-diastolic diameter (LVEDD). Age was also inversely correlated with E (r = -0.36), septal e`(r = -0.53) and lateral e`(r = -0.53). On multivariable analysis, E was inversely correlated with diastolic BP and LVEDD, septal e`was inversely correlated with diastolic BP and positively correlated with SWT and LVEDL, after adjusting for body mass index, whilst lateral e`was inversely correlated with diastolic BP and positively correlated with LVEDL.ConclusionThe above findings are consistent with higher BP being a contributor to age-related reductions in both E and e`and shortening of LVEDL with age being a contributor to the age-related reduction in e`. An implication of these findings is that slowing of myocyte relaxation is unlikely to be the sole, and may not be the main, mechanism underlying age-related decreases in E and e`.
Highlights
There is a progressive change in the pattern of left ventricular (LV) filling during normal aging which begins early in adult life [1,2], and results in substantial differences in LV filling between young and elderly subjects [3,4,5,6]
Age was positively correlated with diastolic blood pressure (BP) and septal wall thickness (SWT), inversely correlated with left ventricular end-diastolic length (LVEDL) (β = -0.25) after adjustment for sex and body surface area, but was not related to left ventricular end-diastolic diameter (LVEDD)
E was inversely correlated with diastolic BP and LVEDD, septal ewas inversely correlated with diastolic BP and positively correlated with SWT and LVEDL, after adjusting for body mass index, whilst lateral ewas inversely correlated with diastolic BP and positively correlated with LVEDL
Summary
There is a progressive change in the pattern of left ventricular (LV) filling during normal aging which begins early in adult life [1,2], and results in substantial differences in LV filling between young and elderly subjects [3,4,5,6]. Aging is associated with a gradual reduction in the peak velocity of LV long axis early diastolic motion (e) [6,9,10,11,12,15,16,17], an echocardiographic variable in common use for the assessment of LV relaxation, and as a correction factor for E in the estimation of mean left atrial (LA) pressure [18,19] It has been more than 25 years since an effect of age on LV filling was first described [7], there has been ongoing uncertainty regarding the mechanisms underlying this effect [1,2,6,20,21,22]. This study investigated the possible contributions of blood pressure (BP) and left ventricular end-diastolic length (LVEDL) to age-related reductions in E and e.
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