Abstract 15551: Age-Related and Blood Pressure-Related Changes in Echocardiographic Indices of Cardiac Remodeling
Background: Diastolic Heart failure increases with advancing ages. Age-related cardiac remodeling has been suggested, but changes in echocardiographic indices in advancing ages remain to be investigated in association with 24-h blood pressure (BP).
Methods: We performed 24-h ambulatory BP monitoring and echocardiography in 669 elderly patients (74.1±0.3 yrs; men, 42%) with treated hypertension. We related LV systolic and diastolic dimensions, left atrial dimension, LV mass indices (LVMI), LV relative wall thickness (RWT), fractional shortening (FS), and indices of LV diastolic filling including ratio of E-wave to A-wave (E/A ratio) and the deceleration time of the E-wave velocity (Dct) to age, sex, body mass index (BMI), 24-h BPs, agents for hypertension treatment, smoking and diabetes mellitus.
Results: With advancing ages LV dimension decreased (diastolic, r= -0.18; systolic, r= -0.19, both p=0.001) and concentric LV remodeling developed (RWT, r=0.12, p=0.001). LVMI and FS were unchanged from 41 to 94 yrs old. Mean 24-h systolic/ diastolic BPs were 130±1/ 71±0mmHg. Mean nocturnal systolic/ diastolic BPs were 125±1/ 68±0mmHg. Nocturnal systolic BPs increased with advancing ages (r=0.11, p=0.004), whereas 24-h systolic BPs were unchanged and well controlled. BMI (r=0.17), nocturnal (r=0.25), and 24-h systolic BPs (r=0.25) were significantly related to LVMI. Nocturnal (r=0.17) and 24-h systolic BPs (r=0.16) were significantly related to concentric LV remodeling, which was associated with indices of diastolic LV filling (E/A ratio, r= -0.19, Dct, r=0.14, p=0.001). In the multiple linear regression analysis, concentric LV remodeling but not LVMI was an independent determinant of indices of LV diastolic filling (E/A ratio; Dct, both r=0.001), after adjustment for age, sex, BMI, and mean 24-h systolic BPs. Moreover, only in female diabetes mellitus was an independent determinant of E/A ratio after adjustment for the confounders.
Conclusion: Cardiac remodeling with advancing ages was characterized by decreasing LV dimensions and concentric LV remodeling. Diastolic dysfunction was associated with concentric LV remodeling even after adjustment for 24-h systolic BPs. Diabetes mellitus in female might exacerbate diastolic filling abnormality.
- © 2011 by American Heart Association, Inc.