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Noninvasive assessment of left ventricular and myocardial contractility in middle-aged men and women: disparate evolution above the age of 50?

¹Cardiovascular Mechanics and Biofluid Dynamics Research Unit, Institute of Biomedical Technology; ²Ghent University Hospital, Department of Cardiovascular Diseases; and ³Ghent University, Department of Epidemiology and Public Health, Ghent, Belgium

Submitted 14 July 2006 ; accepted in final form 17 October 2006

End-systolic elastance (E_es) is a frequently used index of left ventricular (LV) contractility. However, because of its inherent dependence on LV geometry, E_es cannot be used to compare myocardial contractile state between ventricles with different geometries, which is the case in any cross-sectional study. Various normalization methods for E_es have been proposed in the literature, but a standardized method is still lacking. In this study, we introduced a novel alternative normalization technique and compared it with three previously suggested methods. We tested all normalization methods to assess the age- and sex-related differences in myocardial contractility in a large population sample of 2,184 middle-aged (ages, 35–55 yr) untreated subjects free from overt cardiovascular disease. Ventricular contractility E_es was determined using a previously validated noninvasive single-beat method, based on two-dimensional echocardiographic and brachial blood pressure measurements. Myocardial contractility was estimated as 1) E_es·end-diastolic volume (EDV); 2) E_es·LV mass (LVM); 3) 0.433·E_es·LVM/relative wall thickness (RWT), based on a theoretical LV model; and 4) 0.0941·E_es·LVM^0.455·RWT^–0.159, a novel semiempirical expression derived in this study. Because of the difference in their underlying assumptions, the various myocardial contractility indexes do not provide consistent information with respect to sex differences. Despite these discrepancies, it was found that myocardial contractility in women appears to be better preserved after the age of 50 yr compared with that in men. The physiological mechanisms behind this potentially clinically important phenomenon at population level require further investigation.

elastance; single beat; left ventricular mechanics; population

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