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J Am Coll Cardiol, 1998; 32:1221-1227
© 1998 by the American College of Cardiology Foundation
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CLINICAL STUDIES

Coupled systolic-ventricular and vascular stiffening with age

Implications for pressure regulation and cardiac reserve in the elderly

Chen-Huan Chen, MD*, Masaru Nakayama, MD, PhD§, Erez Nevo, MD, DSc{ddagger}, Barry J. Fetics, BE, MSE{ddagger}, W. Lowell Maughan, MD{ddagger} and David A. Kass, MD{ddagger}

* Veterans General Hospital-Taipei and National Yang-Ming University, Taipei, People’s Republic of China
{ddagger} Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
§ Division of Cardiology, St. Marianna University Hospital, Kawasaki, Japan

Manuscript received February 25, 1998; revised manuscript received June 24, 1998, accepted July 6, 1998.

Address for correspondence: Dr. David A. Kass, Halsted 500, Division of Cardiology, The Johns Hopkins Hospital, 600 N Wolfe Street, Baltimore, Maryland 21287
dkass{at}eureka.wbme.jhu.edu

Objectives. We tested the hypothesis that age-related arterial stiffening is matched by ventricular systolic stiffening, and that both enhance systolic pressure sensitivity to altered cardiac preload.

Background. Arterial rigidity with age likely enhances blood pressure sensitivity to ventricular filling volume shifts. Tandem increases in ventricular systolic stiffness may also occur and could potentially enhance this sensitivity.

Methods. Invasive left ventricular pressure-volume relations were measured by conductance catheter in 57 adults aged 19 to 93 years. Patients had normal heart function and no cardiac hypertrophy and were referred for catheterization to evaluate chest pain. Twenty-eight subjects had normal coronary angiography and hemodynamics, and the remaining had either systolic hypertension or coronary artery disease without infarction. Data recorded at rest and during transient preload reduction by inferior vena caval obstruction yielded systolic and diastolic left ventricular chamber and effective arterial stiffness and pulse pressure.

Results. Left ventricular volumes, ejection fraction and heart rate were unaltered by age, whereas vascular load and stiffening increased (p < 0.008). Arterial stiffening (Ea) was matched by increased ventricular systolic stiffness (Ees): , (r = 0.50, p < 0.0001), maintaining arterial-heart interaction (Ea/Ees ratio) age-independent. Ventricular systolic and diastolic stiffnesses correlated (r = 0.51, p < 0.0001) and increased with age (p < 0.03). Both ventricular and vascular stiffening significantly increased systolic pressure sensitivity to cardiac preload (p < 0.006).

Conclusions. Arterial stiffening with age is matched by ventricular systolic stiffening even without hypertrophy. The two effects contribute to elevating systolic pressure sensitivity to altered chamber filling. In addition to recognized baroreflex and autonomic dysfunction with age, combined stiffening could further enhance pressure lability with diuretics and postural shifts in the elderly.

Abbreviations and Acronyms
  Ea = arterial elastance
  Ed = end diastolic elastance
  EDV = end diastolic volume
  Ees = end systolic elastance
  EF = ejection fraction
  LV = left ventricular
  PP = pulse pressure
  PV = pressure volume
  SBPEDV = slope of systolic blood pressure-end diastolic volume relation
  SV = stroke volume




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