CLINICAL STUDY: HEART FAILURE
Cardiac cycle-dependent changes in aortic area and distensibility are reduced in older patients with isolated diastolic heart failure and correlate with exercise intolerance
W. Gregory Hundley, MD, FACC*  ,
Dalane W. Kitzman, MD, FACC*,
Timothy M. Morgan, PhD ,
Craig A. Hamilton, PhD,
Stephen N. Darty, RTN*,
Kathryn P. Stewart, RDMS*,
David M. Herrington, MD, MHS, FACC* ,
Kerry M. Link, MD and
William C. Little, MD, FACC*
* Department of Internal Medicine (Cardiology Section), the Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
Department of Radiology (Division of Radiologic Sciences), the Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
Department of Public Health Sciences, the Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
Manuscript received October 23, 2000;
revised manuscript received May 24, 2001,
accepted June 4, 2001.
Reprint requests and correspondence: Dr. W. Gregory Hundley, Section on Cardiology, Wake Forest University School of Medicine, (Bowman Gray Campus), Medical Center Bovlevard, Winston-Salem, North Carolina 27157-1045
ghundley{at}wfubmc.edu
OBJECTIVES
The goal of this study was to determine if cardiac cycle-dependent changes in proximal thoracic aortic area and distensibility are associated with exercise intolerance in elderly patients with diastolic heart failure (DHF).
BACKGROUND
Aortic compliance declines substantially with age. We hypothesized that a reduction in cardiac cycle-dependent changes in thoracic aortic area and distensibility (above that which occurs with aging) could be associated with the exercise intolerance that is prominent in elderly diastolic heart failure patients.
METHODS
Thirty subjects (20 healthy individuals [10 < 30 years of age and 10 > 60 years of age] and 10 individuals > the age of 60 years with DHF) underwent a magnetic resonance imaging (MRI) study of the heart and proximal thoracic aorta followed within 48 h by maximal exercise ergometry with expired gas analysis.
RESULTS
The patients with DHF had higher resting brachial pulse and systolic blood pressure, left ventricular mass, aortic wall thickness and mean aortic flow velocity, and, compared with healthy older subjects, they had a significant reduction in MRI-assessed cardiac cycle-dependent change in aortic area and distensibility (p < 0.0001) that correlated with diminished peak exercise oxygen consumption (r = 0.79). After controlling for age and gender in a multivariate analysis, thoracic aortic distensibility was a significant predictor of peak exercise oxygen consumption (p < 0.04).
CONCLUSIONS
Older patients with isolated DHF have reduced cardiac cycle-dependent changes in proximal thoracic aortic area and distensibility (beyond that which occurs with normal aging), and this correlates with and may contribute to their severe exercise intolerance.
|
Abbreviations and Acronyms
| | DHF | = diastolic heart failure | | FOV | = field of view | | HF | = heart failure | | HO | = healthy old | | LV | = left ventricular or left ventricle | | MRI | = magnetic resonance imaging | | TE | = echo time | | TR | = repetition time | | VO2 | = volume of oxygen |
|
This article has been cited by other articles:
|
|
|
|
 
H. Pavlopoulos and P. Nihoyannopoulos
Pulse pressure/stroke volume: a surrogate index of arterial stiffness and the relation to segmental relaxation and longitudinal systolic deformation in hypertensive disease
Eur J Echocardiogr,
June 1, 2009;
10(4):
519 - 526.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. P. Patrianakos, F. I. Parthenakis, D. Karakitsos, E. Nyktari, and P. E. Vardas
Proximal aortic stiffness is related to left ventricular function and exercise capacity in patients with dilated cardiomyopathy
Eur J Echocardiogr,
May 1, 2009;
10(3):
425 - 432.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Rerkpattanapipat, R. B. D'Agostino Jr, K. M. Link, E. Shahar, J. A. Lima, D. A. Bluemke, S. Sinha, D. M. Herrington, and W. G. Hundley
Location of Arterial Stiffening Differs in Those With Impaired Fasting Glucose Versus Diabetes: Implications for Left Ventricular Hypertrophy From the Multi-Ethnic Study of Atherosclerosis
Diabetes,
April 1, 2009;
58(4):
946 - 953.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Matyal
Newly Appreciated Pathophysiology of Ischemic Heart Disease in Women Mandates Changes in Perioperative Management: A Core Review
Anesth. Analg.,
July 1, 2008;
107(1):
37 - 50.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Park, J.-W. Ha, C. Y. Shim, E.-Y. Choi, J.-M. Kim, J.-A. Ahn, S.-W. Lee, S.-J. Rim, and N. Chung
Gender-Related Difference in Arterial Elastance During Exercise in Patients With Hypertension
Hypertension,
April 1, 2008;
51(4):
1163 - 1169.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Van den Bergh, A. Vanderper, P. Vangheluwe, F. Desjardins, I. Nevelsteen, W. Verreth, F. Wuytack, P. Holvoet, W. Flameng, J.-L. Balligand, et al.
Dyslipidaemia in type II diabetic mice does not aggravate contractile impairment but increases ventricular stiffness
Cardiovasc Res,
January 15, 2008;
77(2):
371 - 379.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N.-H. Pan, H.-M. Tsao, N.-C. Chang, Y.-J. Chen, and S.-A. Chen
Aging Dilates Atrium and Pulmonary Veins: Implications for the Genesis of Atrial Fibrillation
Chest,
January 1, 2008;
133(1):
190 - 196.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. A. Borlaug, V. Melenovsky, M. M. Redfield, K. Kessler, H.-J. Chang, T. P. Abraham, and D. A. Kass
Impact of Arterial Load and Loading Sequence on Left Ventricular Tissue Velocities in Humans
J. Am. Coll. Cardiol.,
October 16, 2007;
50(16):
1570 - 1577.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Balmain, N. Padmanabhan, W. R. Ferrell, J. J. Morton, and J. J.V. McMurray
Differences in arterial compliance, microvascular function and venous capacitance between patients with heart failure and either preserved or reduced left ventricular systolic function
Eur J Heart Fail,
September 1, 2007;
9(9):
865 - 871.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. P. Shapiro, C. S.P. Lam, J. B. Patel, S. F. Mohammed, M. Kruger, D. M. Meyer, W. A. Linke, and M. M. Redfield
Acute and Chronic Ventricular-Arterial Coupling in Systole and Diastole: Insights From an Elderly Hypertensive Model
Hypertension,
September 1, 2007;
50(3):
503 - 511.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. G. Hundley, E. Bayram, C. A. Hamilton, E. A. Hamilton, T. M. Morgan, S. N. Darty, K. P. Stewart, K. M. Link, D. M. Herrington, and D. W. Kitzman
Leg flow-mediated arterial dilation in elderly patients with heart failure and normal left ventricular ejection fraction
Am J Physiol Heart Circ Physiol,
March 1, 2007;
292(3):
H1427 - H1434.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. F. Mitchell, R. S. Vasan, M. J. Keyes, H. Parise, T. J. Wang, M. G. Larson, R. B. D'Agostino Sr, W. B. Kannel, D. Levy, and E. J. Benjamin
Pulse Pressure and Risk of New-Onset Atrial Fibrillation
JAMA,
February 21, 2007;
297(7):
709 - 715.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Melenovsky, B. A. Borlaug, B. Rosen, I. Hay, L. Ferruci, C. H. Morell, E. G. Lakatta, S. S. Najjar, and D. A. Kass
Cardiovascular Features of Heart Failure With Preserved Ejection Fraction Versus Nonfailing Hypertensive Left Ventricular Hypertrophy in the Urban Baltimore Community: The Role of Atrial Remodeling/Dysfunction
J. Am. Coll. Cardiol.,
January 16, 2007;
49(2):
198 - 207.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T Weber, J Auer, M F O'Rourke, C Punzengruber, E Kvas, and B Eber
Prolonged mechanical systole and increased arterial wave reflections in diastolic dysfunction
Heart,
November 1, 2006;
92(11):
1616 - 1622.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Klotz, I. Hay, G. Zhang, M. Maurer, J. Wang, and D. Burkhoff
Development of Heart Failure in Chronic Hypertensive Dahl Rats: Focus on Heart Failure With Preserved Ejection Fraction
Hypertension,
May 1, 2006;
47(5):
901 - 911.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. M. Cardis, D. A. Fyfe, and W. T. Mahle
Elastic Properties of the Reconstructed Aorta in Hypoplastic Left Heart Syndrome.
Ann. Thorac. Surg.,
March 1, 2006;
81(3):
988 - 991.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. F. Mitchell, J. M. O. Arnold, M. E. Dunlap, T. X. O'Brien, G. Marchiori, E. Warner, C. B. Granger, S. S. Desai, and M. A. Pfeffer
Pulsatile hemodynamic effects of candesartan in patients with chronic heart failure: The CHARM Program
Eur J Heart Fail,
March 1, 2006;
8(2):
191 - 197.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P M Mottram, B A Haluska, R Leano, S Carlier, C Case, and T H Marwick
Relation of arterial stiffness to diastolic dysfunction in hypertensive heart disease
Heart,
December 1, 2005;
91(12):
1551 - 1556.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. P. V. Dantas and K. Sandberg
Regulation of ACE2 and ANG-(1-7) in the aorta: new insights into the renin-angiotensin system in the control of vascular function
Am J Physiol Heart Circ Physiol,
September 1, 2005;
289(3):
H980 - H981.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. A. Kass
Ventricular Arterial Stiffening: Integrating the Pathophysiology
Hypertension,
July 1, 2005;
46(1):
185 - 193.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. R. Heerman, P. Segers, C. D. Roosens, F. Gasthuys, P. R. Verdonck, and J. I. Poelaert
Echocardiographic assessment of aortic elastic properties with automated border detection in an ICU: in vivo application of the arctangent Langewouters model
Am J Physiol Heart Circ Physiol,
May 1, 2005;
288(5):
H2504 - H2511.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. F. O'Rourke and W. W. Nichols
Aortic Diameter, Aortic Stiffness, and Wave Reflection Increase With Age and Isolated Systolic Hypertension
Hypertension,
April 1, 2005;
45(4):
652 - 658.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. K. Munagala, C. Y.T. Hart, J. C. Burnett Jr, D. M. Meyer, and M. M. Redfield
Ventricular Structure and Function in Aged Dogs With Renal Hypertension: A Model of Experimental Diastolic Heart Failure
Circulation,
March 8, 2005;
111(9):
1128 - 1135.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Steendijk
Heart failure with preserved ejection fraction. Diastolic dysfunction, subtle systolic dysfunction, systolic-ventricular and arterial stiffening, or misdiagnosis?
Cardiovasc Res,
October 1, 2004;
64(1):
9 - 11.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. M. Herrington, W. V. Brown, L. Mosca, W. Davis, B. Eggleston, W. G. Hundley, and J. Raines
Relationship Between Arterial Stiffness and Subclinical Aortic Atherosclerosis
Circulation,
July 27, 2004;
110(4):
432 - 437.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Klapholz, M. Maurer, A. M. Lowe, F. Messineo, J. S. Meisner, J. Mitchell, J. Kalman, R. A. Phillips, R. Steingart, E. J. Brown Jr, et al.
Hospitalization for heart failure in the presence of a normal left ventricular ejection fraction: Results of the New York heart failure registry
J. Am. Coll. Cardiol.,
April 21, 2004;
43(8):
1432 - 1438.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. Ikonomidis, J. Lekakis, K. Stamatelopoulos, N. Markomihelakis, P. G. Kaklamanis, and M. Mavrikakis
Aortic elastic properties and left ventricular diastolic function in patients with Adamantiades-Behcet's disease
J. Am. Coll. Cardiol.,
March 17, 2004;
43(6):
1075 - 1081.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. J. Oliver and D. J. Webb
Noninvasive Assessment of Arterial Stiffness and Risk of Atherosclerotic Events
Arterioscler. Thromb. Vasc. Biol.,
April 1, 2003;
23(4):
554 - 566.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Bonapace, A. Rossi, M. Cicoira, L. Franceschini, G. Golia, L. Zanolla, P. Marino, and P. Zardini
Aortic Distensibility Independently Affects Exercise Tolerance in Patients With Dilated Cardiomyopathy
Circulation,
April 1, 2003;
107(12):
1603 - 1608.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Kawaguchi, I. Hay, B. Fetics, and D. A. Kass
Combined Ventricular Systolic and Arterial Stiffening in Patients With Heart Failure and Preserved Ejection Fraction: Implications for Systolic and Diastolic Reserve Limitations
Circulation,
February 11, 2003;
107(5):
714 - 720.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. W. Kitzman, W. C. Little, P. H. Brubaker, R. T. Anderson, W. G. Hundley, C. T. Marburger, B. Brosnihan, T. M. Morgan, and K. P. Stewart
Pathophysiological Characterization of Isolated Diastolic Heart Failure in Comparison to Systolic Heart Failure
JAMA,
November 6, 2002;
288(17):
2144 - 2150.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Schillaci, L. Pasqualini, P. Verdecchia, G. Vaudo, S. Marchesi, C. Porcellati, G. de Simone, and E. Mannarino
Prognostic significance of left ventricular diastolic dysfunction in essential hypertension
J. Am. Coll. Cardiol.,
June 19, 2002;
39(12):
2005 - 2011.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. F. O'Rourke
Diastolic heart failure, diastolic left ventricular dysfunction and exercise intolerance
J. Am. Coll. Cardiol.,
September 1, 2001;
38(3):
803 - 805.
[Full Text]
[PDF]
|
|
|
|
