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.
References
- Kannel WB, McGee D, Gordon T. A general cardiovascular risk profile: the Framingham Study. Am J Cardiol. 1976;38:46–51[CrossRef][Web of Science][Medline]
- Dargie HJ, McMurray JJ, McDonagh TA. Heart failure—implications of the true size of the problem. J Intern Med. 1996;239:309–315[CrossRef][Web of Science][Medline]
- Mandinov L, Eberli FR, Seiler C, Hess OM. Diastolic heart failure. Cardiovasc Res. 2000;45:813–825
[Abstract/Free Full Text] - Eur Heart J. 1998;19:990–1003
[Free Full Text] - Garcia MJ, Rodriguez L, Ares M. Myocardial wall velocity assessment by pulsed Doppler tissue imaging: characteristic findings in normal subjects. Am Heart J. 1996;132:648–656[CrossRef][Web of Science][Medline]
- Hatle L, Sutherland G. Regional myocardial function—a new approach. Eur Heart J. 2000;21:1337–1357
[Free Full Text] - Henein MY, Gibson DG. Normal long axis function. Heart. 1999;81:111–113
[Free Full Text] - Wang K, Ho SY, Gibson DG, Anderson RH. Architecture of atrial musculature in humans. Br Heart J. 1995;73:559–565
[Abstract/Free Full Text] - Greenbaum RA, Ho SY, Gibson DG, Becker AE, Anderson RH. Left ventricular fibre architecture in man. Br Heart J. 1981;45:248–263
[Abstract/Free Full Text] - Gulati VK, Katz WE, Follansbee WP, Gorcsan J 3rd. Mitral annular descent velocity by tissue Doppler echocardiography as an index of global left ventricular function. Am J Cardiol. 1996;77:979–984[CrossRef][Web of Science][Medline]
- Pfisterer ME, Battler A, Zaret BL. Range of normal values for left and right ventricular ejection fraction at rest and during exercise assessed by radionuclide angiocardiography. Eur Heart J. 1985;6:647–655
[Abstract/Free Full Text] - Port S, Cobb FR, Coleman RE, Jones RH. Effect of age on the response of the left ventricular ejection fraction to exercise. N Engl J Med. 1980;303:1133–1137[Abstract]
- Slotwiner DJ, Devereux RB, Schwartz JE. Relation of age to left ventricular function in clinically normal adults. Am J Cardiol. 1998;82:621–626[CrossRef][Web of Science][Medline]
- Wandt B, Bojo L, Hatle L, Wranne B. Left ventricular contraction pattern changes with age in normal adults. J Am Soc Echocardiogr. 1998;11:857–863[CrossRef][Web of Science][Medline]
- Henein MY, O'Sullivan C, Davies SW, Sigwart U, Gibson DG. Effects of acute coronary occlusion and previous ischaemic injury on left ventricular wall motion in humans. Heart. 1997;77:338–345
[Abstract/Free Full Text] - Rodriguez L, Garcia M, Ares M, Griffin BP, Nakatani S, Thomas JD. Assessment of mitral annular dynamics during diastole by Doppler tissue imaging: comparison with mitral Doppler inflow in subjects without heart disease and in patients with left ventricular hypertrophy. Am Heart J. 1996;13:982–987
- Ryder KM, Benjamin EJ. Epidemiology and significance of atrial fibrillation. Am J Cardiol. 1999;84:131R–138R[CrossRef][Web of Science][Medline]
- Kaul S, Tei C, Hopkins JM, Shah PM. Assessment of right ventricular function using two-dimensional echocardiography. Am Heart J. 1984;107:526–531[CrossRef][Web of Science][Medline]
- Webb-Peploe KM, Henein MY, Coats AJ, Gibson DG. Echo derived variables predicting exercise tolerance in patients with dilated and poorly functioning left ventricle. Heart. 1998;80:565–569
[Abstract/Free Full Text] - Ghio S, Recusani F, Klersy C. Prognostic usefulness of the tricuspid annular plane systolic excursion in patients with congestive heart failure secondary to idiopathic or ischemic dilated cardiomyopathy. Am J Cardiol. 2000;85:837–842[CrossRef][Web of Science][Medline]
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