“Accelerated aging” of the heart as heart failure with preserved ejection fraction—analysis using leg-positive pressure stress echocardiography

• Published in: The International Journal of Cardiovascular Imaging Vol. 37; no. 8; pp. 2473 - 2482
• Main Authors: Shono, Ayu, Matsumoto, Kensuke, Yamada, Nao, Kusunose, Kenya, Suzuki, Makiko, Sumimoto, Keiko, Tanaka, Yusuke, Yamashita, Kentaro, Shibata, Nao, Yokota, Shun, Suto, Makiko, Dokuni, Kumiko, Tanaka, Hidekazu, Hirata, Ken-ichi
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.08.2021; Springer Nature B.V
• Subjects: Age; Aging; Cardiac Imaging; Cardiology; Cardiovascular system; Congestive heart failure; Echocardiography; Ejection fraction; Geriatrics; Heart failure; Hemodynamics; Imaging; Medicine; Medicine & Public Health; Multivariate analysis; Older people; Original Paper; Pathophysiology; Physiology; Radiology; Risk analysis; Risk factors; Stress; Stroke volume; Variance analysis; Ventricle; Heart failure with preserved ejection fraction; Aging; Leg-positive pressure stress; Preload reserve
• ISSN: 1569-5794; 1573-0743; 1875-8312
• DOI: 10.1007/s10554-021-02258-4

The aging process is a significant risk factor for heart failure. The incidence of heart failure with preserved ejection fraction (HFpEF) dramatically increases with age. Although HFpEF occurs along a continuum of aging of the cardiovascular system, the pathophysiology that differentiates overt HFpEF from physiological aging is not fully understood. A total of 102 subjects were prospectively recruited: 25 patients with HFpEF and 77 healthy controls. Controls were stratified into three age-groups: young (n = 27, 20–40 years), middle aged (n = 25, 40–65 years), and elderly (n = 25, > 65 years). All participants underwent preload stress echocardiography using a leg-positive pressure (LPP) maneuver. With an increase in age, progressive concentric left ventricular (LV) remodeling was observed in healthy controls, resulting in the hemodynamic consequences of an age-dependent increase in the E/e’ ratio (ANOVA, P  < 0.001). During LPP stress, the E/e’ ratio significantly increased in the middle-aged and elderly groups (from 8 ± 2 to 9 ± 3, from 10 ± 2 to 12 ± 3, P  < 0.05, respectively), and this was more pronounced in patients with HFpEF (from 16 ± 5 to 17 ± 7, P  < 0.05). Forward stroke volume (SV) significantly increased in each healthy group during LPP stress (all P  < 0.001) but failed to increase in the HFpEF group (from 43 ± 13 to 44 ± 14 mL/m 2 , P  = 0.65). In a multivariate analysis, LV mass index (odds ratio [OR] 1.051, P  < 0.05), E/e’ ratio (OR 1.480; P  < 0.05), and change in SV (OR 0.780; P  < 0.05) were independent parameters that differentiated HFpEF from physiological aging. Structural remodeling and impaired preload reserve may both be critical features that characterize the pathophysiology of HFpEF.