Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
Circ Heart Fail. 2013 Sep 1;6(5):944-52. doi: 10.1161/CIRCHEARTFAILURE.113.000383. Epub 2013 Jun 28.
Cross-sectional studies suggest that left ventricular (LV) and arterial elastance (stiffness) increase with age, but data examining longitudinal changes within human subjects are lacking. In addition, it remains unknown whether age-related LV stiffening is merely a reaction to arterial stiffening or caused by other processes.
Comprehensive echo-Doppler cardiography was performed in 1402 subjects participating in a randomly selected community-based study at 2 examinations separated by 4 years. From this population, 788 subjects had adequate paired data to determine LV end-systolic elastance (Ees), end-diastolic elastance (Eed), and effective arterial elastance. Throughout 4 years, blood pressure, arterial elastance, and LV mass decreased, coupled with significantly greater use of antihypertensive medications. However, despite reductions in arterial load, Ees increased by 14% (2.10±0.67-2.26±0.70 mm Hg/mL; P<0.0001) and Eed increased by 8% (0.13±0.03-0.14±0.04 mm Hg/mL; P<0.0001). Increases in Eed were greater in women than men, whereas Ees changes were similar. Age-related increases in Ees and Eed were correlated with changes in body weight, but were similar in subjects with or without cardiovascular disease. Changes in Ees were correlated with Eed (r=0.5; P<0.0001), but not with other measures of contractility, indicating that the increase in Ees was reflective of passive stiffening rather than enhanced systolic function.
Despite reductions in arterial load with medical therapy, LV systolic and diastolic stiffness increase over time in humans, particularly in women. In addition to blood pressure control, therapies targeting load-independent ventricular stiffening may be effective to treat and prevent age-associated cardiovascular diseases, such as heart failure.
横断面研究表明，左心室（LV）和动脉僵硬度（僵硬度）随年龄增长而增加，但缺乏关于人体纵向变化的研究数据。此外，尚不清楚与年龄相关的 LV 僵硬度仅仅是对动脉僵硬度的反应，还是由其他过程引起的。
在一项为期 4 年的 2 次检查的随机选择的社区基础研究中，对 1402 名参与者进行了全面的超声心动图 - 多普勒心动图检查。从该人群中，有 788 名参与者有足够的配对数据来确定左心室收缩末期僵硬度（Ees）、舒张末期僵硬度（Eed）和有效动脉僵硬度。在 4 年内，血压、动脉僵硬度和 LV 质量下降，同时降压药物的使用明显增加。然而，尽管动脉负荷降低，但 Ees 增加了 14%（2.10±0.67-2.26±0.70 mm Hg/mL；P<0.0001），Eed 增加了 8%（0.13±0.03-0.14±0.04 mm Hg/mL；P<0.0001）。Eed 的增加在女性中大于男性，而 Ees 的变化相似。Ees 和 Eed 的年龄相关性增加与体重变化相关，但在有或没有心血管疾病的患者中相似。Ees 的变化与 Eed 相关（r=0.5；P<0.0001），但与其他收缩性指标无关，这表明 Ees 的增加反映了被动僵硬度的增加，而不是增强的收缩功能。
尽管通过药物治疗降低了动脉负荷，但 LV 收缩和舒张僵硬度在人类中随时间推移而增加，尤其是在女性中。除了控制血压外，针对负荷独立的心室僵硬度的治疗方法可能对治疗和预防与年龄相关的心血管疾病（如心力衰竭）有效。
