Gardin J M, Arnold A M, Bild D E, Smith V E, Lima J A, Klopfenstein H S, Kitzman D W
Department of Medicine, University of California, Irvine, USA.
Am J Cardiol. 1998 Aug 1;82(3):345-51. doi: 10.1016/s0002-9149(98)00339-7.
Changes in left ventricular (LV) diastolic function (e.g., as measured by transmitral flow velocity) are known to occur with aging. In addition, impaired LV diastolic function plays an important role in such cardiovascular disorders common in the elderly as hypertension, ischemic heart disease, and congestive heart failure (CHF). Participants in the Cardiovascular Health Study, a multicenter study of community-dwelling men (n=2,239) and women (n=2,962) > or = 65 years of age, underwent an extensive baseline evaluation, including echocardiography. Early diastolic LV Doppler (transmitral) peak filling velocity decreased, and peak late diastolic (atrial) velocity increased with age in multivariate analyses (all p <0.001). Early and late diastolic peak filling velocities were both significantly higher in women than in men, even after adjustment for body surface area (or height and weight). In multivariate models in the entire cohort and a healthy subgroup (n=703), gender, age, heart rate, and blood pressure (BP) were most strongly related to early and late diastolic transmitral peak velocities. Early and late diastolic peak velocities both increased with increases in systolic BP and decreased with increases in diastolic BP (p <0.001). Doppler transmitral velocities were compared among health status subgroups. In multiple regression models adjusted for other covariates, and in analysis of variance models examining differences across subgroups adjusted only for age, the subgroup with CHF had the highest early diastolic peak velocities. All clinical disease subgroups had higher late diastolic peak velocities than the healthy subgroup, with the subgroups with either CHF or hypertension having the highest age-adjusted means. The subgroup with hypertension had the lowest ratio of early-to-late diastolic peak velocity, and men with CHF had the highest ratio. These findings are consistent with previous reports that hypertensive subjects exhibit an abnormal relaxation pattern, whereas patients with CHF develop a pattern suggestive of an increased early diastolic left atrial-LV pressure gradient.
已知左心室（LV）舒张功能的变化（例如，通过二尖瓣血流速度测量）会随着年龄增长而出现。此外，左心室舒张功能受损在老年人常见的心血管疾病中起重要作用，如高血压、缺血性心脏病和充血性心力衰竭（CHF）。心血管健康研究的参与者为年龄≥65岁的社区居住男性（n = 2239）和女性（n = 2962），他们接受了包括超声心动图在内的广泛基线评估。在多变量分析中，舒张早期左心室多普勒（二尖瓣）峰值充盈速度随年龄下降，舒张晚期（心房）峰值速度随年龄增加（所有p<0.001）。即使在调整体表面积（或身高和体重）后，女性舒张早期和晚期峰值充盈速度均显著高于男性。在整个队列和健康亚组（n = 703）的多变量模型中，性别、年龄、心率和血压（BP）与舒张早期和晚期二尖瓣峰值速度关系最为密切。舒张早期和晚期峰值速度均随收缩压升高而增加，随舒张压升高而降低（p<0.001）。对健康状况亚组的二尖瓣多普勒速度进行了比较。在调整了其他协变量的多元回归模型中，以及在仅调整年龄以检查亚组间差异的方差分析模型中，CHF亚组的舒张早期峰值速度最高。所有临床疾病亚组的舒张晚期峰值速度均高于健康亚组，CHF或高血压亚组的年龄调整均值最高。高血压亚组的舒张早期与晚期峰值速度之比最低，CHF男性的比值最高。这些发现与先前的报告一致，即高血压患者表现出异常的舒张模式，而CHF患者则呈现出提示舒张早期左心房-左心室压力梯度增加的模式。
