Clinical Investigation
Ventricular Mechanics
Age- and Gender-Dependency of Left Ventricular Geometry Assessed with Real-Time Three-Dimensional Transthoracic Echocardiography

https://doi.org/10.1016/j.echo.2011.01.011Get rights and content

Background

Aging and gender may affect left ventricular (LV) mechanics. The aim of this study was to determine the age and gender dependency of LV mechanical indices obtained from real-time three-dimensional echocardiography (RT3DE).

Methods

RT3DE was performed in 280 healthy subjects (age range, 1–88 years; 137 men). From full-volume data sets, LV endocardial and epicardial borders were semiautomatically traced using quantitative software. LV volumes and corresponding long-axis diameter were measured throughout the cardiac cycle. Sphericity index was defined as the ratio of LV volume and spherical volume, calculated as 4/3 × π × (long-axis diameter/2)3. LV mass was calculated as (LV epicardial volume − LV endocardial volume) × 1.05. The ratio of LV mass to LV volume was also calculated.

Results

The mean value of LV ejection fraction did not change with age. However, LV volumes, mass, sphericity index, and LV mass/volume ratio were altered by age: (1) sphericity index was highest in the first decade of age and then declined until the fifth decade, (2) LV mass/volume ratio significantly increased in older age, and (3) LV mass/volume ratio was significantly higher in aged women compared with age-matched men.

Conclusions

Age has heterogeneous effects on LV shape and LV mass/volume ratio, potentially due to the growing process of myocardial fibers and the surrounding architecture in the younger population, as well as the aging process, with an increase in vascular stiffness and a loss of myocytes in older populations. Higher LV mass/volume ratios in older women might be a contributor to the preferential development of diastolic heart failure in this population.

Section snippets

Study Subjects

A total of 322 healthy subjects over a wide range of ages (1–88 years; 150 men) were enrolled. Eligibility criteria included (1) normal blood pressure without a history of hypertension, (2) absence of diabetes and/or cardiovascular disease, and (3) no cardiac medication use. Subjects were recruited from three university hospitals from the United States and Japan and were predominantly hospital employees or their relatives and/or volunteers recruited through advertisements. All subjects

Results

Of the 322 subjects screened, 42 (13%) were excluded from analysis because of elevated systolic blood pressure (>140 mm Hg; n = 23) at the time of physical examination or poor image quality (n = 19). Thus, the final study group consisted of 280 subjects (mean age, 38 ± 24 years; age range, 1–88 years; 137 men).

Discussion

The main findings of this study were as follows. First, LV volumes, stroke volume, and LV mass were age dependent, in agreement with previous studies using cardiac magnetic resonance imaging.16, 17, 18, 19 Specifically, LV volumes and mass increased until the fourth decade of life and decreased thereafter, and the LV mass/volume ratio was age dependent, suggesting that changes in LV volume and mass were not uniform and varied with age, particularly in the older decades of life. Second, LV EF

Conclusions

Aging and gender significantly affect LV morphologic changes, even in normal subjects. Thus, the classification of age-specific and gender-specific normal values should be required when assessing LV geometry, especially in patients with pressure-overload hypertrophy, such as those with hypertension and aortic stenosis. RT3DE is a noninvasive and feasible method to evaluate age-related and gender-related changes in LV geometry.

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    Dr. Lang has received research grants from Philips Medical Systems (Andover, MA).

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