Age Dependency of Left Ventricular Diastolic Function in Pressure Overload Hypertrophy

• Published in: Journal of the American College of Cardiology 1997-01, Vol.29 (1), p.181-186
• Main Authors: Villari, Bruno, Vassalli, Giuseppe, Schneider, Jakob, Chiariello, Massimo, Hess, Otto M.
• Format: Article
• Language: English
• Subjects: Adaptation, Physiological - physiology; Age Factors; Aged; Aging - physiology; Aortic Valve Stenosis - complications; Aortic Valve Stenosis - physiopathology; Biological and medical sciences; Cardiac Catheterization; Cardiology. Vascular system; Case-Control Studies; Endocardial and cardiac valvular diseases; Female; Heart; Humans; Hypertrophy, Left Ventricular - diagnosis; Hypertrophy, Left Ventricular - etiology; Hypertrophy, Left Ventricular - physiopathology; Male; Medical sciences; Middle Aged; Myocardial Contraction - physiology; Ventricular Function, Left - physiology
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(96)00440-8

Objectives. We sought to evaluate whether age is a determinant of left ventricular (LV) pressure overload hypertrophy and whether diastolic function influenced the aging process. Background. The adaptation of the left ventricle to chronic pressure overload is a complex process of hormonal, structural and hemodynamic factors. Different responses in the elderly patients have been described. Methods. LV biplane cineangiography, micromanometry and endomyocardial biopsies were carried out in 57 patients with pure or predominant aortic stenosis. Patients were classified into a senior (65 years; mean age 70 ± 4 years, n = 22) study group. LV systolic function was evaluated from biplane ejection fraction and midwall fractional shortening, whereas diastolic function was assessed from the time constant of LV pressure decay, peak filling rate and the constant of myocardial stiffness. Biopsy samples were examined morphometrically for interstitial fibrosis, fibrous content, muscle fiber diameter and volume fraction of myofibrils. Results. Gender distribution and the severity of aortic stenosis were comparable in the two patient groups. LV peak systolic and end-diastolic pressures were significantly higher in the elderly than in the senior group. LV ejection fraction and midwall fractional shortening were comparable in the two groups. The time constant of relaxation and the myocardial stiffness constant were greater in the elderly than in the senior group whereas the early peak filling rate was significantly reduced in the elderly group. Interstitial fibrosis was increased, although not significantly (p < 0.06), and fibrous content was enhanced (p < 0.001) in elderly patients with respect to the senior group. There was a linear correlation between age and myocardial stiffness (r = 0.55, p < 0.0001) and an inverse relation between age and early peak filling rate (r = 0.52, p < 0.0001). Conclusions. In the presence of a comparable degree of aortic valve stenosis, elderly patients (>65 years) present with more severe LV hypertrophy than do senior patients (