Effect of ageing on left ventricular compliance and distensibility in healthy sedentary humans

Abstract

Key points• Healthy sedentary ageing leads to stiffening of the heart; however, when this process occurs during ageing has been unknown.• In this study, 70 healthy sedentary subjects were stratified into four groups: 'young' -G 21−34 :21-34 years; 'early middle-age' -G 35−49 : 35-49 years; 'late middle-age' -G 50−64 : 50-64 years; and 'seniors' -G ≥65 : ≥65 years.• Invasive catheter measurements showed a substantially greater left ventricular (LV) compliance (more flexible/less stiff) in G 21−34 than G 50−64 and G ≥65 .• Although LV chamber compliance in G 50−64 and G ≥65 appeared identical, pressure-volume curves were shifted leftward, exhibiting a smaller volume for any given pressure with increasing age.• Our results suggest that LV stiffening with ageing occurs during the transition between youth and middle-age and becomes manifest between the ages of 50-64; LV volume contraction and remodelling follow in the senior years. Early-late middle age thus may represent a 'sweet spot' when interventions to prevent stiff ageing hearts may be most effective.Abstract Healthy, but sedentary ageing leads to marked atrophy and stiffening of the heart, with substantially reduced cardiac compliance; but the time course of when this process occurs during normal ageing is unknown. Seventy healthy sedentary subjects (39 female; 21-77 years) were recruited from the Dallas Heart Study, a population-based, random community sample and enriched by a second random sample from employees of Texas Health Resources. Subjects were highly screened for co-morbidities and stratified into four groups according to age: G 21−34 : 21-34 years, G 35−49 : 35-49 years, G 50−64 : 50-64 years, G ≥65 : ≥65 years. All subjects underwent invasive haemodynamic measurements with right heart catheterization to define Starling and left ventricular (LV) pressure-volume curves. LV end-diastolic volumes (EDV) were measured by echocardiography at baseline, −15 and −30 mmHg lower-body negative pressure, and 15 and 30 ml kg −1 saline infusion with simultaneous measurements of pulmonary capillary wedge pressure. There were no differences in heart rate or blood pressures among the four groups at baseline. Baseline EDV index was smaller in G ≥65 than other groups. LV diastolic pressure-volume curves confirmed a substantially greater LV compliance in G 21−34 compared with G 50−64 and G ≥65 , resulting in greater LV volume changes with preload manipulations. Although LV chamber compliance in G 50−64 and G ≥65 appeared identical, pressure-volume curves were shifted leftward, toward a decreased distensibility, with increasing age. These results suggest that LV stiffening in healthy ageing occurs during the transition between youth and middle-age and becomes manifest between the ages of 50 to 64. Thereafter, this LV stiffening is followed by LV volume contraction and remodelling after the age of 65.

The pathophysiology of heart failure with preserved ejection fraction

“…LV diastolic stiffness increases with normal ageing, even when blood pressure is well-controlled and LV mass does not increase. 50,[54][55][56] In addition to passive chamber stiffness, diastolic relaxation also becomes compromised with ageing, impairing the effects of diastolic suction. [51][52][53] Age has no effect on resting heart rate, contractility, or cardiac output but, even in healthy adults, ageing blunts the capacity to enhance heart rate, systolic function, and cardiac output in response to exercise.…”

“…27 In many ways, this situation is an exaggerated version of phenomena seen with normal cardiovascular ageing. [47][48][49][50][51][52][53][54][55][56][57] Therefore, HFpEF could be considered to be the ultimate form of premature cardiac ageing or 'presbycardia' . These limitations in cardio vascular reserve then interact with systemic processes to cause symptoms of dyspnoea and fatigue, which ultimately culminate in systemic and pulmonary venous congestion, muscle wasting, and loss of functionality and independence, escalating the need for HF care.…”

Exercise Training as Therapy for Heart Failure

“…Even healthy aging leads to cardiac stiffening(16,17) that can be prevented by lifelong exercise training. (17) Aging also leads to slowing of relaxation, a seemingly inevitable consequence of senescence that is not modified even by prolonged and intensive training.…”

Impact of Lifelong Exercise “Dose” on Left Ventricular Compliance and Distensibility

“…Sedentary but healthy aging has been shown to have deleterious effects on the cardiovascular (CV) system, including stiffening of the vasculature and left ventricle (1–3). This stiffening plays a key role in the pathophysiology of many common CV conditions affecting the elderly, including hypertension, left ventricular (LV) hypertrophy, atrial fibrillation, and heart failure with preserved ejection fraction (HFpEF) (2).…”