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CLINICAL RESEARCH

Age and gender affect ventricular-vascular coupling during aerobic exercise

Samer S. Najjar, MD^*,*, Steven P. Schulman, MD, Gary Gerstenblith, MD, FACC, Jerome L. Fleg, MD, FACC^*, David A. Kass, MD, Frances O'Connor, MPH^*, Lewis C. Becker, MD and Edward G. Lakatta, MD^*

^* Laboratory of Cardiovascular Science, National Institute on Aging, NIH, Baltimore, Maryland, USA
Division of Cardiology, Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA

Manuscript received September 29, 2003; revised manuscript received February 12, 2004, accepted April 13, 2004.

^* Reprint requests and correspondence: Dr. Samer S. Najjar, Laboratory of Cardiovascular Science, National Institute on Aging, National Institutes of Health, 5600 Nathan Shock Drive, Baltimore, Maryland 21224, USA.
NajjarSa{at}grc.nia.nih.gov

OBJECTIVES: The goal of this study was to examine the age-associated differences in ventricular-vascular coupling, defined by the ratio of arterial elastance (EaI) to left ventricular systolic elastance (E_LVI), and its components, at rest and during exercise.

BACKGROUND: Ejection fraction (EF) increases during exercise, but the EF reserve decreases with aging. Ejection fraction is inversely related to EaI/E_LVI, an index of the interaction between arterial and ventricular properties, which is an important determinant of cardiac performance. Thus, age differences in EaI/E_LVI during exercise, due to age differences in EaI, E_LVI, or both, may help to explain the age deficit in EF reserve.

METHODS: We noninvasively characterized EaI/E_LVI = end-systolic volume index (ESVI)/stroke volume index (SVI) and its two determinants EaI = end-systolic pressure/SVI, and E_LVI = end-systolic pressure/ESVI, at rest and during exercise in 239 healthy men and women (age range, 21 to 87 years). Blood pressures were assessed with cuff sphygomanometry, and cardiac volumes with gated blood pool scintingraphy.

RESULTS: Resting EaI/E_LVI was not age related in men or women. In both sexes, EaI/E_LVI decreased during exercise and declined to a lesser extent in older subjects. There were gender differences in the components of EaI/E_LVI during exercise: EaI was greater in older versus young women (p = 0.01) but was unaffected by age in men. Left ventricular systolic elastance increased to a greater extent in young versus older subjects (p = 0.0001 for men, p = 0.07 for women).

CONCLUSIONS: Age-associated differences in EaI/E_LVI occur in both genders during exercise. Sub-optimal ventricular-vascular coupling helps to explain the age-associated blunting of maximal exercise EF, and its underlying mechanisms appear to differ between men and women.

Abbreviations and Acronyms   BP = blood pressure   DBP = diastolic blood pressure   EaI = effective arterial elastance index   EF = ejection fraction   ELVI = left ventricular systolic elastance index   ESP = end-systolic pressure   ESVI = end-systolic volume index   LV = left ventricle/ventricular   PP = pulse pressure   SBP = systolic blood pressure   SVI = stroke volume index

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