Ventricular Vascular Coupling: Correlates and Prognosis

描述（由申请人提供）：进行性左心室（LV）重构是心力衰竭（CHF）的基本基础。随着年龄的增长，左室和血管重构（VVR）的改变，即更硬的心脏进入不顺应的血管树，易患CHF，特别是舒张性CHF。先前的研究表明，在左室重构、血管僵硬和舒张功能障碍方面存在性别差异。我们建议通过并发超声心动图（echo）和动脉血压计对Framingham心脏研究（FHS）后代和Omni队列的3500名参与者进行VVR和舒张功能评估。我们将测试4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上的差异，并导致女性对舒张期CHF的更大易感性。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血管刚度和左室测量的纵向变化。4. 左室加速和血管老化的个体更容易发生HTN、CHF和血管事件（CVD）。我们的具体目的是研究：1)血管刚度测量与左室重构之间的横断面关系；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了血管刚度的纵向变化和左室重构；(4) VVR、舒张功能、左室纵向变化和血管刚度测量与HTN、CHF和CVD发生率的关系。FHS特别适合这一建议，因为它提供了一个大的、单一地点的、以社区为基础的中年至老年男性和女性样本，并提供了广泛的先前风险因素数据。即将到来的检查周期是进行血管检查和回声的理想选择，因为老年参与者的血管僵硬度、左室舒张功能障碍和CHF风险明显增加。在之前的检查中测量左室和血管刚度有助于评估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.