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，左心室和血管重塑(VVR)的改变，即更硬的心脏射入不顺应性血管树，容易发生CHF，特别是舒张期CHF。先前的研究表明，在左心室重构、血管僵硬和舒张期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(ECHO)和动脉血压测量来评估3500名弗雷明翰心脏研究(FHS)后代和OMNI队列的VVR和舒张期功能。我们将检验四个主要假说：1.动脉僵硬的性别差异导致女性与男性在左心室质量、几何形状和收缩功能上的差异，以及女性对舒张性充血性心力衰竭的更大易感性。2.环境和遗传因素影响LV舒张期功能；3.环境和遗传因素决定血管硬度和LV测量的纵向变化。4.左心室和血管老化加速的个体更容易发生HTN、CHF和血管事件(CVD)。我们的具体目的是检查：1)血管僵硬指标和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僵硬和左室重构的纵向变化；4)室颤指标、舒张期功能指标和左室及血管僵硬指标的纵向变化与HTN、CHF和CVD的发生率的关系。FHS是唯一适合这一建议的，因为它提供了一个大型的、单一地点的、基于社区的中年老年男性和女性样本，具有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测试和回声的理想选择，因为老年参与者的血管僵硬、左室舒张功能障碍和充血性心力衰竭风险显著增加。先前检查时的LV和血管硬度测量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.