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Relationship among diastolic intraventricular pressure gradients, relaxation, and preload: impact of age and fitness

Zoran B. Popovi,¹ Anand Prasad,² Mario J. Garcia,¹ Armin Arbab-Zadeh,² Allen Borowski,¹ Erika Dijk,² Neil L. Greenberg,¹ Benjamin D. Levine,² and James D. Thomas¹

¹Cardiovascular Imaging Center, The Cleveland Clinic Foundation, Cleveland, Ohio; and ²Institute for Exercise and Environmental Medicine, Presbyterian Hospital and University of Texas Southwestern Medical Center at Dallas, Dallas, Texas

Submitted 23 August 2005 ; accepted in final form 8 November 2005

Diastolic intraventricular pressure gradients (IVPGs) are a measure of the ability of the ventricle to facilitate its filling using diastolic suction. We assessed 15 healthy young but sedentary subjects, aged <50 yr (young subjects; age, 35 ± 9 yr); 13 healthy but sedentary seniors, aged >65 yr with known reductions in ventricular compliance (elderly sedentary subjects; age, 70 ± 4 yr); and 12 master athletes, aged >65 yr, previously shown to have preserved ventricular compliance (elderly fit subjects; age, 68 ± 3 yr). Pulmonary capillary wedge pressure (PCWP) and echocardiography measurements were performed at baseline, during load manipulation by lower body negative pressure at –15 and –30 mmHg, and after saline infusion of 10 and 20 ml/kg (elderly) or 15 and 30 ml/kg (young). IVPGs were obtained from color M-mode Doppler echocardiograms. Baseline IVPGs were lower (1.2 ± 0.4 vs. 2.4 ± 0.7 mmHg, P < 0.0001), and the time constant of pressure decay (₀) was longer (60 ± 10 vs. 46 ± 6 ms, P < 0.0001) in elderly sedentary than in young subjects, with no difference in PCWP. Although PCWP changes during load manipulations were similar (P = 0.70), IVPG changes were less prominent in elderly sedentary than in young subjects (P = 0.02). Changes in stroke volume and IVPGs during loading manipulations correlated (r = 0.96, P = 0.0002). PCWP and ₀ were strong multivariate correlates of IVPGs (P < 0.001, for both). IVPG response to loading interventions in elderly sedentary and elderly fit subjects was similar (P = 0.33), despite known large differences in ventricular compliance. The ability to regulate IVPGs during changes in preload is impaired with aging. Preserving ventricular compliance during aging by lifelong exercise training does not prevent this impairment.

aging; diastolic function; pulmonary capillary wedge pressure; isovolumic relaxation

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