Impact of right ventricular distensibility on congestive heart failure with preserved left ventricular ejection fraction in the elderly

Abstract

To elucidate involvement of age-related impairments of right ventricular (RV) distensibility in the elderly congestive heart failure (CHF), we examined the prevalence of less-distensible right ventricle in patients with preserved left ventricular ejection fraction (LVEF) over a wide range of ages. In 893 patients aged from 40 to 102 years, we simultaneously recorded electrocardiogram, phonocardiogram, and jugular venous pulse wave. Using signal-processing techniques, the prominent 'Y' descent of jugular pulse waveform was detected as a hemodynamic sign of a less-distensible right ventricle. Prevalence of less-distensible right ventricle and elevated RV systolic pressure increased along with aging from the 50s to the 90s in an exponential fashion from 3.3 and 12% up to 33 and 61%, respectively (p < 0.001 for each). This age-dependent deterioration of ventricular distensibility was not observed for the left ventricle. Higher age and higher RV systolic pressure were independently associated with less-distensible right ventricle (Odds ratio, 1.05 per 1 year, p = 0.003; and 1.03 per 1 mmHg, p = 0.026, respectively). The elderly CHF was associated with high prevalence of the less-distensible right ventricle and higher RV systolic pressure, both of which were independent risk factors for CHF (Odds ratio, 5.27, p = 0.001, and 1.08 per 1 mmHg, p < 0.001, respectively). In elderly patients with preserved LVEF, the combination of a less-distensible right ventricle and a high RV systolic pressure seems to be related to developing CHF. The less-distensible right ventricle and elevated RV systolic pressure are closely associated with CHF with preserved LVEF in the elderly patients.

Prominent ‘Y’ descent is an ominous sign of a poorer prognosis in heart failure with preserved ejection fraction

“…In our previous study, DT of mitral early flow was prolonged before the increase in the incidence of a less-distensible right ventricle and elevated RV systolic pressure. 7 Our previous data also support that a lessdistensible right ventricle often originates from elevated RV afterload associated with LV diastolic dysfunction. Elevated LV filling pressure itself may directly influence RV Table 1 Contingency table for evaluation of RV distensibility Cardiologist B Distensible right ventricle Less-distensible right ventricle Totals Cardiologist A Distensible right ventricle 193 3 196 Less-distensible right ventricle 1 125 126 Totals 194 128 322 Prominent 'Y' descent and a poorer prognosis in HFpEF Data are number of patients (%), median (interquartile range), or mean ± SD.…”

“…6 Deterioration of RV afterload may cause RV diastolic dysfunction, resulting in a lessdistensible right ventricle. 7 Olivetti et al found that aging was accompanied by a decrease in myocyte nuclei of 14 million/year and an increase in reactive cellular hypertrophy of the right ventricle. 7 Our previous data also support that a lessdistensible right ventricle often originates from elevated RV afterload associated with LV diastolic dysfunction.…”

“…18 Agerelated change may also affect RV distensibility. 7 Olivetti et al found that aging was accompanied by a decrease in myocyte nuclei of 14 million/year and an increase in reactive cellular hypertrophy of the right ventricle. 19 Hodkinson et al reported that amyloid deposition was detected in nearly half of the patients over 70 years old.…”

“…7 The jugular venous pulse was recorded in the supine position by welltrained cardiac sonographers. 7 The jugular venous pulse was recorded in the supine position by welltrained cardiac sonographers.…”

“…The methods to measure and judge the jugular venous pulse were the same as those in our previous report. 7 The jugular venous pulse was recorded in the supine position by welltrained cardiac sonographers. A pulse-wave transducer (TY-306, Fukuda Denshi, Tokyo, Japan) was placed over the neck, above and to the right of the junction of the right clavicle and the manubrium sterni, and held in place manually ( Figure 2).…”