Diastolic dysfunction in the elderly subjects. Disease or a physiological manifestation of ageing?

Czech version

Authors: J. Meluzín ^1,2; H. Podroužková ^1,2; Z. Gregorová ^1,2; R. Panovský ^1,2
Authors‘ workplace: I. interní kardio‑angiologická klinika Lékařské fakulty MU a FN u sv. Anny Brno, přednostka prof. MU Dr. Lenka Špinarová, Ph. D., FESC ¹; Oddělení kardiovaskulárních chorob ICRC Brno, vedoucí programu MU Dr. Marek Orban ²
Published in: Vnitř Lék 2013; 59(5): 392-396
Category: Review

Overview

Aim:
The purpose of this summary paper is to discuss the current knowledge of the impact of age on diastolic function of the left ventricle.

Data from the literature:
Reports published till this time have convincingly demonstrated a significant relationship of age to diastolic function of the left ventricle. Ageing is a physiological process accompanied by structural changes in both myocardium and arterial bed resulting in worsening of parameters characterizing the left ventricular diastolic function. This „physiological” diastolic dysfunction in the elderly subjects can be explained by the deterioration of passive left ventricular filling properties and by worsening of left ventricular relaxation. The detailed analysis of published reports shows problems in distiguishing this „physiological” diastolic dysfunction resulting from physiological tissue ageing from „pathological” diastolic dysfunction reflecting a disease of cardiovascular system.

Conclusion:
To interprete correctly values of parameters quantifying diastolic function of the left ventricle, one should take into account the age of subjects under the examination. Further studies are necessary to distinguish exactly „physiological” deterioration of diastolic function associated with ageing from really „pathological” diastolic dysfunction in the elderly subjects.

Key words:
ageing – echocardiography – diastolic dysfunction – diastolic heart failure

Sources

1. Redfield MM, Jacobsen SJ, Burnett JC et al. Burden of systolic and diastolic ventricular dysfunction in the community. JAMA 2003; 289: 194– 202.

2. Owan TE, Hodge DO, Herges RM et al. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 2006; 355: 251– 259.

3. Bhatia RS, Tu JV, Lee DS et al. Outcome of heart failure with preserved ejection fraction in a population‑based study. N Engl J Med 2006; 355: 260– 269.

4. Steinberg BA, Zhao X, Heidenreich PA et al. Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction. Prevalence, therapies, and outcomes. Circulation 2012; 126: 65– 75.

5. Ho JE, Gona P, Pencina MJ et al. Discriminating clinical features of heart failure with preserved vs. reduced ejection fraction in the community. Eur Heart J 2012; 33: 1734– 1741.

6. Paulus WJ, Tschope C, Sanderson JE et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J 2007; 28: 2539– 2550.

7. McMurray JJV, Adamopoulos S, Anker SD et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur Heart J 2012; 33: 1787– 1847.

8. Zile MR, Baicu CF, Gaasch WH. Diastolic heart failure – abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med 2004; 350: 1953– 1959.

9. Yamamoto K, Redfield MM, Nishimura RA. Analysis of left ventricular diastolic function. Heart 1996; 75: (Suppl. 2): 27– 35.

10. Nagueh SF, Appleton ChP, Gillebert TC et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 2009; 10: 165– 193.

11. Hradec J. Srdeční selhání s normální ejekční frakcí. Kardiol Rev 2008; 10: 111– 116.

12. Hradec J. Diastolické srdeční selhání. Diagnostika, epidemiologie, prognóza. Kardiol Rev 2004; 4: 156– 160.

13. Paleček T, Linhart A. Echokardiografické hodnocení diastolické funkce levé komory: co dokážeme v roce 2009. Cor Vasa 2009; 51: 789– 804.

14. Munagala VK, Jacobsen SJ, Mahoney DW et al. Association of newer diastolic function parameters with age in healthy subjects: a population‑based study. J Am Soc Echocardiogr 2003; 16: 1049– 1056.

15. De Sutter J, De Backer J, Van de Veire N et al. Effects of age, gender, and left ventricular mass on septal mitral annulus velocity (E‘) and the ratio of transmitral early peak velocity to E‘ (E/ E‘). Am J Cardiol 2005; 95: 1020– 1023.

16. Peverill RE, Gelman JS, Mottram PM et al. Factors associated with mitral annular systolic and diastolic velocities in healthy adults. J Am Soc Echocardiogr 2004; 17: 1146– 1154.

17. Tighe DA, Vinch CS, Hill JC et al. Influence of age on assessment of diastolic function by Doppler tissue imaging. Am J Cardiol 2003; 91: 254– 257.

18. Downes TR, Nomeir AM, Smith KM et al. Mechanism of altered pattern of left ventricular filling with aging in subjects without cardiac disease. Am J Cardiol 1989; 64: 523– 527.

19. Prasad A, Okazaki K, Zadeh AA et al. Abnormalities of Doppler measures of diastolic function in the healthy elderly are not related to alterations of left atrial pressure. Circulation 2005; 111: 1499– 1503.

20. Bahl VK, Dave TH, Sundaram KR et al. Pulsed Doppler echocardiographic indices of left ventricular diastolic function in normal subjects. Clin Cardiol 1992; 15: 504– 512.

21. Henein M, Lindqvist P, Francis D et al. Tissue Doppler analysis of age‑ dependency in diastolic ventricular behaviour and filling. Eur Heart J 2002; 23: 162– 171.

22. Mantero A, Gentile F, Qualtierotti C et al. Left ventricular diastolic parameters in 288 normal subjects from 20 to 80 years old. Eur Heart J 1995; 16: 94– 105.

23. Bryg RJ, Williams GA, Labovitz AJ. Effect of aging on left ventricular diastolic filling in normal subjects. Am J Cardiol 1987; 59: 971– 974.

24. Ling L, Kistler PM, Ellims AH et al. Diffuse ventricular fibrosis in atrial fibrillation. J Am Coll Cardiol 2012; 60: 2402– 2408.

25. Debessa CRG, Maifrino LBM, De Souza RR. Age related changes of the collagen network of the human heart. Mech Ageing Dev 2001; 122: 1049– 1058.

26. Eghbali M, Eghbali M, Robinson TF et al. Collagen accumulation in heart ventricles as a function of growth and aging. Cardiovasc Res 1989; 23: 723– 729.

27. Kasner M, Westermann D, Lopez B et al. Diastolic tissue Doppler indexes correlate with the degree of collagen expression and cross‑linking in heart failure and normal ejection fraction. J Am Coll Cardiol 2011; 57: 977– 985.

28. Martos R, Baugh J, Ledwidge M et al. Diastolic heart failure. Evidence of increased myocardial collagen turnover linked to diastolic dysfunction. Circulation 2007; 115: 888– 895.

29. Marti CN, Gheotghiade M, Kalogeropoulos AP et al. Endothelial dysfunction, arterial stiffness, and heart failure. J Am Coll Cardiol 2012; 60: 1455– 1469.

30. Borlaug BA, Nishimura RA, Sorajja P et al. Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction. Circ Heart Fail 2010; 3: 588– 595.

31. Okada RD, Osbakken MD, Boucher ChA et al. Pulmonary blood volume ratio response to exercise: a noninvasive determination of exercise‑induced changes in pulmonary capillary wedge pressure. Circulation 1982; 65: 126– 133.

32. Thadani U, Parker JO. Hemodynamics at rest and during supine and sitting bicycle exercise in normal subjects. Am J Cardiol 1978; 41: 52– 59.

33. Maeder MT, Thompson BR, Brunner‑ La Rocca HP et al. Hemodynamic basis of exercise limitation in patients with heart failure and normal ejection fraction. J Am Coll Cardiol 2010; 56: 855– 863.