Ventricular Vascular Coupling: Correlates and Prognosis

描述（由申请人提供）：进行性左心室（LV）重塑是心力衰竭（CHF）的基本基质。LV和血管重塑（VVR）随年龄的变化，即，更僵硬的心脏喷射到不顺应的血管树中，易患CHF，尤其是舒张期CHF。先前的研究表明，在左室重塑、血管僵硬和舒张功能障碍方面存在性别差异。我们建议通过同步超声心动图（回声）和动脉张力测定法评估3500例FHS后代和Omni队列的VVR和舒张功能。我们将测试四个主要假设：1。动脉硬度的性别差异导致女性与男性在左室质量、几何形状和收缩功能方面的差异，并导致女性对舒张期CHF的易感性更高。2.环境和遗传因素影响左室舒张功能。环境和遗传因素决定了血管硬度和LV测量的纵向变化。4. LV和血管老化加速的个体更容易发生HTN、CHF和血管事件（CVD）。我们的具体目标是检查：1）血管硬度测量和左室重构之间的横截面关系; 2）左室舒张功能指标的环境和遗传相关性; 3）环境和遗传因素决定血管硬度和左室重构的纵向变化; 4）VVR、舒张功能、LV纵向变化和血管僵硬度指标与HTN、CHF和CVD发生率的关系。FHS是唯一适合这个建议，因为它提供了一个大的，单一的网站，以社区为基础的样本，中年到老年男性和女性广泛的前期风险因素的数据。即将到来的检查周期是进行血管测试和超声心动图的理想选择，因为老年参与者正在经历血管僵硬度、LV舒张功能障碍和CHF风险的显著增加。既往检查时的LV和血管僵硬度测量有助于评价纵向变化和相关风险。

DESCRIPTION (provided by applicant): Progressive left ventricular (LV) remodeling is a fundamental substrate of heart failure (CHF). Alterations in LV and vascular remodeling (VVR) with age, i.e., a stiffer heart ejecting into a noncompliant vascular tree, predispose to CHF, especially diastolic CHF. Prior studies indicate sex differences in LV remodeling, vascular stiffness and diastolic dysfunction. We propose to assess VVR and diastolic function via concurrent echocardiography (echo) and arterial tonometry in 3500 participants of the Framingham Heart Study (FHS) Offspring and Omni cohorts. We will test 4 major hypotheses: 1. Sex differences in arterial stiffness contribute to dissimilarities in LV mass, geometry, and systolic function in women vs. men, and to the greater female susceptibility to diastolic CHF. 2. Environmental and genetic factors influence LV diastolic function, 3. Environmental and genetic factors determine longitudinal changes in vascular stiffness and LV measurements. 4. Individuals with accelerated LV and vascular aging have greater propensity for developing HTN, CHF and vascular events (CVD). Our specific aims are to examine: 1) the cross-sectional relations between vascular stiffness measures and LV remodeling; 2) the environmental and genetic correlates of LV diastolic function indexes; 3) the environmental and genetic factors determine longitudinal changes in vascular stiffness, and LV remodeling; and 4) the relations of measures of VVR, diastolic function, and longitudinal changes in LV and vascular stiffness measures to the incidence of HTN, CHF, and CVD. The FHS is uniquely suited for this proposal because it provides a large, single site, community-based sample of middle-age to older men and women with extensive antecedent risk factor data. The forthcoming examination cycle is ideal to perform vascular testing and echo because the aging participants are experiencing marked increases in vascular stiffness, LV diastolic dysfunction, and CHF risk. LV and vascular stiffness measures at prior examinations facilitate the evaluation of longitudinal changes and associated risk.