Ventricular-arterial coupling in centenarians without cardiovascular diseases.

Abstract

Ventricular-arterial (VA) coupling is a central determinant of cardiovascular system performance and cardiac energetics. This index is expressed by the Ea/Ees ratio, where the effective arterial elastance (Ea) indicates the net arterial load exerted on the left ventricle and the left ventricular end-systolic elastance (Ees) is a load-independent measure of left ventricular chamber performance. Thirty-three centenarians (100.6 ± 1.2years, range 99-105years, 10M) without cardiovascular diseases underwent a complete echocardiographic evaluation and an instantaneous arterial blood pressure measurement, to characterize the Ea/Ees ratio and its two determinants indexed to body surface area. VA coupling was markedly reduced (Ea/Ees ratio 0.40 ± 0.1), reflecting a disproportionate increase in Ees index (8.5 ± 2.2mmHg/ml/m2) compared with Ea index (3.2 ± 0.8mmHg/ml/m2). Notably, the coupling ratio was significantly lower in women (0.37 ± 0.1) than in men (0.45 ± 0.1, p = 0.0003), due to an increase in Ees index significantly greater in women (9.4 ± 1.9mmHg/ml/m2) than in men (6.5 ± 1.5mmHg/ml/m2, p = 0.0002). Using multivariate regression analysis, only female gender (β coefficient -0.04, p = 0.01) and relative wall thickness (β coefficient -0.49, p < 0.0001) showed a significant inverse correlation to VA coupling. Our analysis in a population of centenarians without overt cardiovascular disease revealed very low values of VA coupling, especially in women. Both a LV structural remodeling as well as a high aortic elastance might have contributed to a secondary disproportionate increase in myocardial stiffness.