Copyright © 2002 by the European Society of Cardiology.
Tissue Doppler analysis of age-dependency in diastolic ventricular behaviour and filling. A cross-sectional study of healthy hearts (the Umeå General Population Heart Study)
a Department of Clinical Cardiology, Royal Brompton Hospital, London, U.K.
b Department of Clinical Physiology, Sundsvall Hospital, Sundsvall, Sweden
c Heart Centre, Cardiology Division, Umeå University Hospital, Umeå, Sweden
d Department of Internal Medicine, Cardiology Division, Malar Hospital, Eskilstuna, Sweden
revised September 6, 2001; accepted September 12, 2001
Abstract
Background Much in the diagnosis of diastolic ventricular dysfunction is dependent upon the filling pattern, and most patients diagnosed with diastolic heart failure are elderly. Data from healthy asymptomatic individuals across a range of ages are rare. We sought to find an age-related variation in normal diastolic physiology, specifically the filling pattern and segmental myocardial longitudinal velocities.
Methods and Results To assess the effect of normal ageing on left ventricular longitudinal function, we studied myocardial shortening and lengthening velocities using the tissue Doppler technique in 60 healthy subjects who were randomly selected from the Ume
(Sweden) General Population Register, which represents a wide range of ages (23–88 years). Myocardial velocities were documented at four left ventricular sites (anterior, left, posterior and septal) and at three levels (basal, mid-cavity and apical). Transmitral, transtricuspid and pulmonary venous flow velocities were recorded using pulsed-wave Doppler. While systolic myocardial velocities were conserved across ages, there was a marked decrease in early diastolic velocities with age (from 16cm.s–1at 30 years to 9cm.s–1at 80 years at the basal segment) and a corresponding significant increase in late diastolic velocities (from 10 to 16cm.s–1). Although these findings were most marked at the basal level, they were also clearly manifested at the apical level. Myocardial lengthening velocities were related to transmitral flow velocities, showing a correlation of 0·64 (P<0·0001) in early diastole and 0·68 (P<0·0001) in late diastole. Finally, diastolic pulmonary venous flow velocity was found to correlate with early diastolic myocardial velocities (at the basal level, r=0·53, P<0·0001).
Conclusions Normal ageing causes a decrease in early diastolic and a substantial increase in late diastolic myocardial lengthening velocities. These changes explain the known trends in the transmitral flow pattern with age. In contrast, systolic myocardial velocities do not change significantly with age. These findings should be considered when evaluating diastolic function, especially in the elderly.
f1 Correspondence: Dr Michael Y. Henein, Department of Cardiology, Royal Brompton Hospital, Sydney St, London SW3 6NP, U.K.
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