Galetta Fabio, Franzoni Ferdinando, Femia Francesca R, Bartolomucci Francesco, Carpi Angelo, Santoro Gino
Department of Internal Medicine, University of Pisa School of Medicine, Via Roma, 67, 56126 Pisa, Italy.
Biomed Pharmacother. 2004 Oct;58(8):437-42. doi: 10.1016/j.biopha.2004.08.008.
Advancing age is characterized by structural and functional change of left ventricle (LV) and large elastic arteries. Recent advances in tissue Doppler imaging (TDI) and integrated backscatter (IBS), new ultrasound tools, have allowed non-invasive assessment of structural and functional characterization of myocardium and artery wall. Our aim was to compare LV diastolic function and carotid artery remodeling in elderly athletes and sedentary controls. Twenty-five elderly athletes (males, aged 68.6 +/- 4.2 years) were compared to 25 age-sex-matched sedentary controls. All the subjects underwent either conventional Doppler echocardiography with pulsed TDI to evaluate LV diastolic function, and conventional ultrasonography and integrated backscatter (IBS) analysis to evaluate the carotid wall. Corrected IBS values (C-IBS) were obtained by subtracting the IBS value of the adventitia. Body mass index and blood pressure were not different in the two groups; athletes showed lower heart rate (P < 0.0001) and, as expected, higher LV mass than sedentary subjects (P < 0.0001). Transmitral Doppler analysis showed in trained subjects a significantly lower peak A and a higher E/A ratio (P < 0.001). On regards to TDI measurements, athletes exhibited a higher Em, a lower Am, and, subsequently, an increased Em/Am ratio of both lateral wall and septum (P < 0.0001). The IVRTm was shorter in trained subjects (P < 0.001). Athletes showed a lower C-IBS (-26.8 +/- 2.9 vs. -23.4 +/- 3.8 dB, P < 0.001) and a smaller intima-media thickness (IMT: 0.66 +/- 0.14 vs. 0.80 +/- 0.18 mm, P < 0.001) respect to sedentary controls. Moreover, a significant direct correlation was found between Em/Am of LV septal and lateral wall and C-IBS values (respectively, r = 0.62 and r = 0.56, P < 0.001). Thus the aging heart manifests structural and functional changes in response to physical activity. The expected pattern of cardiac and arterial alterations normally seen in response to age is modified in the older athletes, suggesting the exercise training is an effective stimulus in shaping arterial structure and left ventricular function in older heart. It would appear that pulsed TDI and IBS analysis may play an important role in detecting training-induced LV and carotid artery structural and functional modifications.
衰老的特征是左心室（LV）和大弹性动脉的结构和功能发生变化。组织多普勒成像（TDI）和背向散射积分（IBS）等新型超声工具的最新进展，使得对心肌和动脉壁的结构和功能特征进行无创评估成为可能。我们的目的是比较老年运动员和久坐不动的对照组的左心室舒张功能和颈动脉重塑情况。将25名老年运动员（男性，年龄68.6±4.2岁）与25名年龄、性别匹配的久坐不动的对照组进行比较。所有受试者均接受了常规多普勒超声心动图检查及脉冲TDI以评估左心室舒张功能，以及常规超声检查和背向散射积分（IBS）分析以评估颈动脉壁。校正后的IBS值（C-IBS）通过减去外膜的IBS值获得。两组的体重指数和血压无差异；运动员的心率较低（P<0.0001），且如预期的那样，左心室质量高于久坐不动的受试者（P<0.0001）。二尖瓣多普勒分析显示，训练有素的受试者的A峰明显较低，E/A比值较高（P<0.001）。关于TDI测量，运动员的Em较高，Am较低，因此，侧壁和室间隔的Em/Am比值均增加（P<0.0001）。训练有素的受试者的IVRTm较短（P<0.001）。与久坐不动的对照组相比，运动员的C-IBS较低（-26.8±2.9 vs. -23.4±3.8 dB，P<0.001），内膜中层厚度（IMT）较小（0.66±0.14 vs. 0.80±0.18 mm，P<0.001）。此外，左心室间隔和侧壁的Em/Am与C-IBS值之间存在显著的直接相关性（分别为r = 0.62和r = 0.56，P<0.001）。因此，衰老的心脏会因体力活动而出现结构和功能变化。老年运动员中通常因年龄而出现的心脏和动脉改变的预期模式发生了改变，这表明运动训练是塑造老年心脏动脉结构和左心室功能的有效刺激因素。脉冲TDI和IBS分析似乎在检测训练引起的左心室和颈动脉结构及功能改变方面可能发挥重要作用。
