The Framingham Heart Study, Framingham, MA 01702-5803, USA.
Circulation. 2010 Aug 10;122(6):570-8. doi: 10.1161/CIRCULATIONAHA.110.937821. Epub 2010 Jul 26.
The heart progressively remodels over the life course, yet longitudinal data characterizing such remodeling in the community are limited.
Using multilevel modeling, we analyzed up to 4 serial echocardiographic observations obtained over a 16-year period in 4062 Framingham Heart Study participants (mean age 45 years, 54% women; 11 485 person-observations). We related left ventricular (LV) wall thickness, LV systolic and diastolic dimensions, and fractional shortening to age, sex, body mass index, blood pressure (including antihypertensive medication use), smoking, and diabetes mellitus (separate analyses for each echocardiographic measure). With advancing age, LV dimensions decreased, whereas fractional shortening and LV wall thickness increased concomitantly. Male sex, body mass index, and blood pressure indices/hypertension treatment were significantly related to both greater LV dimensions and LV wall thickness. The effect of age on cardiac remodeling was influenced by key covariates (P<0.05 for all interactions): Women and individuals with diabetes mellitus experienced greater age-associated increases in LV wall thickness; presence of diabetes or a higher blood pressure was associated with a lesser decrease in LV diastolic dimensions with increasing age; and antihypertensive medication use was a marker of an attenuated increase in fractional shortening with aging.
Cardiac remodeling over the adult life course is characterized by a distinct pattern of increasing LV wall thickness, decreasing LV dimensions, and increasing fractional shortening with advancing age. Overall, female sex, greater blood pressure load, and presence of diabetes mellitus serve to attenuate this remodeling pattern. These observations suggest a mechanism for the preponderance of women with hypertension and individuals with diabetes among patients with diastolic heart failure.
心脏在生命过程中逐渐重塑，但描述社区中这种重塑的纵向数据有限。
我们使用多层次模型，分析了 4062 名弗雷明汉心脏研究参与者在 16 年期间获得的多达 4 次超声心动图观察结果（平均年龄 45 岁，54%为女性；11485 人次观察）。我们将左心室（LV）壁厚度、LV 收缩和舒张尺寸以及分数缩短与年龄、性别、体重指数、血压（包括抗高血压药物的使用）、吸烟和糖尿病（分别对每种超声心动图测量进行分析）相关联。随着年龄的增长，LV 尺寸减小，而分数缩短和 LV 壁厚度同时增加。男性、体重指数和血压指数/高血压治疗与 LV 尺寸和 LV 壁厚度都显著相关。年龄对心脏重塑的影响受到关键协变量的影响（所有交互作用的 P<0.05）：女性和糖尿病患者的 LV 壁厚度随年龄增加的幅度更大；存在糖尿病或更高的血压与 LV 舒张尺寸随年龄增加的减少程度降低相关；抗高血压药物的使用是与年龄相关的分数缩短增加幅度减弱的标志。
成年生命过程中的心脏重塑表现为 LV 壁厚度增加、LV 尺寸减小和分数缩短随年龄增加的独特模式。总体而言，女性、更大的血压负荷和糖尿病的存在会减弱这种重塑模式。这些观察结果表明了高血压女性和糖尿病患者中舒张性心力衰竭患者增多的一种机制。
