Relations between aortic stiffness and left ventricular structure and function in older participants in the Age, Gene/Environment Susceptibility--Reykjavik Study.
Relations between aortic stiffness and left ventricular structure and function in older participants in the Age, Gene/Environment Susceptibility--Reykjavik Study.
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DOI：
10.1161/circimaging.114.003039
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发表时间：
2015-04
期刊：
影响因子：
--
通讯作者：
Mitchell GF
中科院分区：
文献类型：
--
作者：
Bell V;Sigurdsson S;Westenberg JJ;Gotal JD;Torjesen AA;Aspelund T;Launer LJ;Harris TB;Gudnason V;de Roos A;Mitchell GF
左心室（LV）收缩使主动脉瓣环移位，并产生拉伸升主动脉的力。我们假设主动脉硬化增加了以前被忽略的左心室负荷，并可能导致肥厚。相反，主动脉牵张相关功代表储存的能量，可能有助于舒张早期充盈。我们在年龄、基因/环境易感性-雷克雅未克研究中对347名参与者（72 - 91岁，189名女性）进行了主动脉和LV的磁共振成像，以检查主动脉牵张与LV结构和功能的关系。主动脉硬度评价为杨氏模量和壁厚的乘积。根据杨氏模量和纵向主动脉应变计算力;功是收缩期间力和瓣环位移的积分乘积。采用面积-长度法测量左室质量和动态容积。根据时间分辨LV容积曲线评估充盈。在校正了年龄、性别、身高、体重、舒张末期左心室容积、增大指数、收缩末期压和心血管疾病危险因素的多变量模型中，主动脉僵硬度升高与左心室质量增加相关（B=3.0±0.8%/SD，P<0.001;性别相互作用，P=0.8）。在男性中，更大的牵张相关主动脉功与增强的早期充盈相关（B=4.0±0.8 mL/SD，P<0.001），但在女性中不相关（B=-0.4 ±0.7 mL/SD，P=0.6）。主动脉僵硬度越高，左室质量越大，与压力无关。仅男性中，更高的拉伸相关工作与更大的舒张早期充盈相关。收缩期近端主动脉牵拉储存的能量的舒张期恢复受损可能导致女性对舒张功能障碍的易感性增加。
Left ventricular (LV) contraction displaces the aortic annulus and produces a force that stretches the ascending aorta. We hypothesized that aortic stiffening increases this previously ignored component of LV load and may contribute to hypertrophy. Conversely, aortic stretch-related work represents stored energy that may facilitate early diastolic filling. We performed magnetic resonance imaging of the aorta and LV in 347 participants (72 to 91 years old, 189 women) in the Age, Gene/Environment Susceptibility-Reykjavik Study to examine relations of aortic stretch with LV structure and function. Aortic stiffness was evaluated as the product of Young’s modulus and wall thickness. Force was computed from Young’s modulus and longitudinal aortic strain; work was the integrated product of force and annulus displacement during systole. LV mass and dynamic volume were measured using the area-length method. Filling was assessed from time-resolved LV volume curves. In multivariable models that adjusted for age, sex, height, weight, end-diastolic LV volume, augmentation index, end-systolic pressure, and cardiovascular disease risk factors, higher aortic stiffness was associated with increased LV mass (B=3.0±0.8% per SD, P<0.001; sex interaction, P=0.8). Greater stretch-related aortic work was associated with enhanced early filling in men (B=4.0±0.8 mL/SD, P<0.001), but not in women (B=−0.4±0.7 mL/SD, P=0.6). Higher aortic stiffness was associated with higher LV mass, independently of pressure. Higher stretch-related work was associated with greater early diastolic filling in men only. Impaired diastolic recovery of energy stored by systolic proximal aortic stretch may contribute to increased susceptibility to diastolic dysfunction in women.