MRI and echocardiographic assessment of the diastolic dysfunction of normal aging: altered LV pressure decline or load?
MRI and echocardiographic assessment of the diastolic dysfunction of normal aging: altered LV pressure decline or load?
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正常衰老舒张功能障碍的 MRI 和超声心动图评估：左心室压力下降或负荷改变？
DOI：
10.1152/ajpheart.01092.2002
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发表时间：
2004
期刊：
影响因子：
--
通讯作者：
Shapiro,EdwardP
中科院分区：
文献类型：
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作者：
Hees,PaulS;Fleg,JeromeL;Dong,Sheng-Jing;Shapiro,EdwardP
正常衰老过程中舒张指数的变化，包括早期充盈速度 (E) 降低、减速时间 (DT) 延长、晚期充盈 (A) 增加和等容舒张时间 (IVRT) 延长，均归因于左心室 (LV) 压力 (LVP) 衰减减慢。事实上，这一系列的发现通常被称为“异常放松”模式。然而，左心室充盈是由房室压力梯度决定的，而房室压力梯度又取决于 LVP 下降和左心房 (LA) 压力 (LAP)。为了评估 LVP 下降和 LAP 的相对影响，我们通过多普勒超声心动图和 MRI 对 122 名 21-92 岁的正常受试者进行了研究。 LVP 下降通过彩色 M 模式 (Vp) 和 LV 解旋率进行评估。使用肺静脉血流收缩分数、肺静脉血流舒张期 DT、彩色 M 模式 (E/Vp) 和组织多普勒 (E/Em) 评估舒张早期 LAP。线性回归显示，随着年龄的增长，E 会减少，A 会增加，IVRT 和 DT 也会延长。年龄与反映 LVP 下降率的参数没有关系。然而，年龄较大与E/Vp降低（P=0.008）和肺静脉收缩分数（P<0.001）、肺静脉DT（P=0.0026）和E/Em（P<0.0001）增加相关，所有这些都表明早期LAP降低。因此，老年人早期充盈减少可能与早期舒张期 LAP 减少比与 LVP 下降减慢更密切相关。这种效应也解释了 IVRT 延长的原因。我们假设 LA 主动或被动特性的变化可能导致衰老过程中异常松弛模式的发展。
Changes in diastolic indexes during normal aging, including reduced early filling velocity (E), lengthenedEdeceleration 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/Vp), and tissue Doppler (E/Em). Linear regression showed the expected reduction ofE, increase inA, 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 reducedE/Vp(P= 0.008) and increased pulmonary vein systolic fraction (P< 0.001), pulmonary vein DT (P= 0.0026), andE/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.