Left ventricular atrioventricular plane displacement is preserved with lifelong endurance training and is the main determinant of maximal cardiac output

Abstract

Key pointsr Ageing has negative effects on cardiac function. r Endurance training in young subjects is known to improve cardiac function and the ability to deliver blood to exercising tissue.r This study shows that lifelong endurance training maintains cardiac pumping function at a level similar to sedentary young subjects and by the same mechanisms.r Healthy untrained elderly subjects have maintained cardiac pumping function but use compensatory mechanisms similar to what is seen in patients with heart failure.r Healthy ageing should include regular physical activity to maintain cardiac function.Abstract Age-related decline in cardiac function can be prevented or postponed by lifelong endurance training. However, effects of normal ageing as well as of lifelong endurance exercise on longitudinal and radial contribution to stroke volume are unknown. The aim of this study was to determine resting longitudinal and radial pumping in elderly athletes, sedentary elderly and young sedentary subjects. Furthermore, we aimed to investigate determinants of maximal cardiac output in elderly. Eight elderly athletes (63 ± 4 years), seven elderly sedentary (66 ± 4 years) and ten young sedentary subjects (29 ± 4 years) underwent cardiac magnetic resonance imaging. All subjects underwent maximal exercise testing and for elderly subjects maximal cardiac output during cycling was determined using a dye dilution technique. Longitudinal and radial contribution to stroke volume did not differ between groups (longitudinal left ventricle (LV) 52-65%, P = 0.12, right ventricle (RV) 77-87%, P = 0.16, radial 7.9-8.6%, P = 1.0). Left ventricular atrioventricular plane displacement (LVAVPD) was higher in elderly athletes and young sedentary compared with elderly sedentary subjects (14 ± 3, 15 ± 2 and 11 ± 1 mm, respectively, P < 0.05). There was no difference between groups for RVAVPD (P = 0.2). LVAVPD was an independent predictor of maximal cardiac output (R 2 = 0.61, P < 0.01, β = 0.78). Longitudinal and radial contributions to stroke volume did not differ between groups. However, how longitudinal pumping was achieved differed; elderly athletes and young sedentary subjects showed similar AVPD whereas this was significantly lower in elderly sedentary subjects. Elderly sedentary subjects achieved longitudinal pumping through increased short-axis area of the ventricle. Large AVPD was a determinant of maximal cardiac output and exercise capacity.

Maternal nutrient restriction during pregnancy and lactation leads to impaired right ventricular function in young adult baboons

“…), similar to the compensatory changes that preserved ventricular stroke volume previously documented in elderly sedentary humans (Steding‐Ehrenborg et al . ). Additionally, with this increase in preload, some improvement of ejection function occurred in the IUGR hearts via the Frank–Starling mechanism.…”

Longitudinal left ventricular function is globally depressed within a week of STEMI

“…Atrioventricular plane displacement is the main contributor to LV SV, counting for 60% in the normal heart (Stephensen et al, 2014). Reduced AVPD has been associated with ageing (Steding-Ehrenborg et al, 2015) and disease (Stephensen et al, 2014), while increased AVPD is seen in male athletes (Steding-Ehrenborg et al, 2013). It is known that MI causes decreased AVPD (Brand et al, 2002) but it is not known how it correlates with MI size and MI location.…”

Aerobic exercise attenuates ageing of the athletic heart

“…Interestingly, the current study by Steding‐Ehrenborg et al . () observed a higher LV‐AVPD in both older athletes and young sedentary compared with the older sedentary participants, without similar changes in right ventricular AVPD. The underlying mechanisms contributing to a ‘mismatch’ in ventricular function were not discussed in the current study.…”

“…In a recent cross‐sectional study in The Journal of Physiology by Steding‐Ehrenborg et al . (), the age‐ and endurance training‐related effects on cardiac function were investigated in older sedentary (66 ± 4 years old), older athletic (63 ± 4 years old) and younger (29 ± 4 years old) sedentary adults. Using cardiac MRI, resting cardiac volumes and contractility indices were determined in an effort to provide novel insights into changes in the contribution of longitudinal and radial pumping to stroke volume (SV) with lifelong endurance training.…”

“…In conclusion, Steding‐Ehrenborg et al . () provide some novel insights into the effects of lifelong exercise training on cardiac function using a strong cardiac MRI‐based methodological approach. In the absence of regular physical activity, it appears that older sedentary subjects may have a lower LV‐AVPD than older athletes, compensated for by a larger short‐axis area of the ventricle.…”