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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

View larger version (73K): [in a new window]   Figure 1 Short-axis magnetic resonance images of the left ventricle (LV) acquired at the midpapillary muscle level at end systole (top row) and the magnitude component of the phase-contrast gradient echo cardiography images of the ascending thoracic aorta (bottom row) from a participant in each of the three patient groups. The myocardium is gray, and the blood pool within the cavity is white in the images of the LV. Increased LV mass relative to cavity size in the patient with diastolic heart failure is displayed in the top right panel. The blackened silhouettes on the images of the aorta represent the difference in aortic area between end diastole and end systole. Cardiac cycle-dependent change in aortic area decreased with advancing age and, importantly, were most reduced in older participants with diastolic heart failure (bottom right).

View larger version (8K): [in a new window]   Figure 2 Measurement of aortic distensibility for participants in each of the patient subgroups. Each symbol represents data from one patient.

View larger version (13K): [in a new window]   Figure 3 Relation between peak volume of oxygen (VO2) (horizontal axis, A and B) and proximal thoracic aortic distensibility (vertical axis, A) and cardiac cycle-dependent changes in aortic area (vertical axis, B) for the 30 participants. Each symbol represents the data from one participant. The regression lines (solid lines) and equations are shown. Solid diamond = healthy young; solid square = healthy old; solid triangle = diastolic heart failure.