Age‐ and sex‐related differences in diastolic function and cardiac dimensions in a hypertensive population

Abstract

AimsThe prevalence of left ventricular diastolic dysfunction increases with age, particularly in hypertensive women. We aimed to determine the age‐ and sex‐related differences in diastolic function, and its relation to alterations of cardiac dimensions in a hypertensive population.Methods and resultsWe enrolled 479 hypertensive patients with a left ventricular ejection fraction (LVEF) ≥50% (men/women, 267/212) and their echocardiographic parameters regarding LV performance and vascular function were measured. Left atrial volume index (LAVI) and operant diastolic elastance (EdI: E/e′/stroke volume index), but not LV mass index (LVMI), correlated weakly with age in both sexes. The arterial elastance index (EaI) and EdI did not differ significantly between sexes in any of the three age groups (A, <65 years; B, ≥65 years but <75 years; C, age ≥75 years). The EdI indexed to EaI, EdI/EaI = E/e′/(0.9 × systolic blood pressure), was significantly more impaired in women than in men only in group C. There were significant differences in LAVI, LVMI, and EdI/EaI between groups B and C only in women.ConclusionsImpairment of diastolic function relative to arterial elasticity, EdI/EaI, occurred in elderly hypertensive women and was coincident with the alteration of cardiac dimensions. The coincidence with the changes in diastolic function and the alterations of cardiac dimensions occurred in a different time point between the sexes.

Fluctuation of Dynamic Diastolic Function Relative to Static Cardiac Structure ― New Insights Into the Underlying Mechanism of Heart Failure With Preserved Ejection Fraction in Elderly Patients ―

“…We therefore sought to determine the age-and sex-related differences in diastolic function relative to arterial elasticity among hypertensive patients with preserved LVEF and no history of HF. 9 We enrolled hypertensive patients with LVEF ≥50% (Table 1), and their echocardiographic parameters regarding arterial elastance and LV performance were measured. There were significant differences in estimated glomerular filtration rate (eGFR) Received November 4, 2016; accepted January 12, 2017; released online January 28, 2017 Background: The mechanisms of heart failure with preserved ejection fraction (HFpEF) need to be clarified immediately.…”

“…This marker of diastolic function assessment was independently associated with heart rate and renal function, in addition to age and LAVI in women, but not in men, in a multivariate analysis. 9 The alteration in heart rate and/or renal function may also be a possible mechanism for exacerbation of diastolic function, leading to the occurrence of incidental HF in elderly women. The clarification of significant factors leading to the fluctuation of E/e' and/or SBP, and the relationship between these factors and heart rate or renal function, may be a novel clue to the mechanism by which elderly women with hypertension are prone to exhibit HFpEF.…”

“…The eGFR and hemoglobin levels decreased with age in both men (r=−0.349, P<0.001, and r=−0.469, P<0.001, respectively) and women (r=−0.418, P<0.001, and r=−0.214, P=0.002, respectively). 9 The effective arterial elastance index (EaI=[0.9×systolic blood pressure (SBP)]/stroke volume index) and operant diastolic elastance index (EdI=E/e'/ stroke volume index) did not differ significantly between the sexes. However, the EdI indexed as EaI, EdI/EaI=E/e'/ (0.9×SBP), a new marker for diastolic function assessment, was significantly more impaired in women than in men only in patients ≥75 years old ( Table 2, t-test).…”

“…There were significant differences in left atrial volume index (LAVI), LV mass index (LVMI), and EdI/EaI between patients aged ≥75 and <75 years, but only among women ( Table 2). 9 Thus, impairment of diastolic function relative to arterial elasticity, EdI/EaI, occurred in elderly women with hypertension and was coincident with alterations in cardiac structure. Importantly, the changes in 2 indices, EdI/EaI and LAVI or LVMI, coincidentally occurred at different time points between the sexes.…”

Transient manifestation of left ventricular diastolic dysfunction following ablation in patients with paroxysmal atrial fibrillation

“…However, the immediate difference in LV diastolic function due to acutely impaired LA compliance between the 2 ablation procedures, possibly resulting from the extent of the isolated area of the posterior LA wall during the acute phase, remains to be seen. We recently reported afterload‐related index for LV diastolic function is significantly higher in elderly (age ≥ 75 years) hypertensive females than in elderly hypertensive males . In this study, we aimed to elucidate the differences in altered LV diastolic function shortly after ablation between patients with paroxysmal AF (PAF) treated with RF ablation and second‐generation CB ablation and to examine the factors that affect the manifestation of an underlying LV diastolic dysfunction in these patients.…”