“Accelerated aging” of the heart as heart failure with preserved ejection fraction—analysis using leg-positive pressure stress echocardiography

AbstractThe aging process is a significant risk factor for heart failure. The incidence of heart failure with preserved ejection fraction (HFpEF) dramatically increases with age. Although HFpEF occurs along a continuum of aging of the cardiovascular system, the pathophysiology that differentiates overt HFpEF from physiological aging is not fully understood. A total of 102 subjects were prospectively recruited: 25 patients with HFpEF and 77 healthy controls. Controls were stratified into three age-groups: young (n  = 27, 20–40 years), middle aged (n = 25, 40–65 years), and elderly (n = 25, >  65 years). All participants underwent preload stress echocardiography using a leg-positive pressure (LPP) maneuver. With an increase in age, progressive concentric left ventricular (LV) remodeling was observed in healthy controls, resulting in the hemodynamic consequences of an age-dependent inc rease in the E/e’ ratio (ANOVA,P <  0.001). During LPP stress, the E/e’ ratio significantly increased in the middle-aged and elderly groups (from 8 ± 2 to 9 ± 3, from 10 ± 2 to 12 ± 3,P <  0.05, respectively), and this was more pronounced in patients with HFpEF (from 16 ± 5 to 17 ± 7,P <  0.05). Forward stroke volume (SV) significantly increased in each healthy group during LPP stress (allP <  0.001) but failed to increase in the HFpEF group (from 43 ± 13 to 44 ± 14 mL/m2,P = 0.65). In a multivar...
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research