Left ventricular remodeling with age in normal men versus women: Novel insights using three-dimensional magnetic resonance imaging

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Abstract

Echocardiographic left ventricular (LV) wall thickness increases with age, suggesting LV hypertrophy. However, autopsy studies have shown no change, or even a decrease, in LV mass with age. With many pathologies, LV remodeling results in changes in ventricular shape. Age-associated LV shape change might explain this discrepancy, although this has not been studied. Magnetic resonance imaging (MRI) was used in 336 healthy, normotensive adults (mean age 56 ± 18 years; 200 women, 136 men) to measure LV mass, end-diastolic LV wall thickness, length, diameter, and shape. Echocardiographic LV mass was measured in a subset of 86 subjects by a standard algorithm. In women, LV wall thickness increased by 14% (r = 0.19, p <0.02), whereas LV length decreased by 9% (r = −0.26, p = 0.0006); LV diameter was unchanged. Thus, LV mass did not vary with age (r −0.04, p = 0.06) and the sphericity index decreased (r = −0.165, p <0.05). In men, LV wall thickness and diameter were unrelated to age, but there was an 11% decrease in LV length (r = −0.29, p = 0.003); therefore, there was an 11% decrease in LV mass (r = −0.20, p = 0.019) and a decrease in the sphericity index (r = −0.218, p <0.04). No change occurred in echocardiographic LV mass with age in either gender, although echocardiographic LV wall thickness increased in both. The left ventricle becomes more spherical with age in normal adults due to reduced LV length. In women, increased LV wall thickness offsets the decreasing LV length, whereas in men, LV wall thickness fails to compensate, resulting in decreased LV mass with age.

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Subjects

Volunteers for this investigation represented a cross-sectional sample from the Baltimore Longitudinal Study of Aging who were studied between 1989 and 1999. This sample included 200 women and 136 men (ages range from 21 to 96 years; median 50 for women; 51 for men). They were healthy, ambulatory, and living within the community, with no evidence of acute or chronic cardiovascular disease, or other debilitating illnesses. In addition, all subjects were screened for the absence of Q waves at

Results

Table 1characterizes the physiologic and anthropometric measurements and the effects of age on these measurements. Both systolic and diastolic blood pressure increased significantly with age in both sexes. Height declined with age in women and men, and men’s weight also decreased with age. Body mass index was not related to age in either gender.

Discussion

We have demonstrated that remodeling of LV structure with age in both genders is characterized mainly by a shortening of the left ventricle along its long axis. In women, the decrease in long-axis length is about 9% over the 7 decades between ages 20 and 90 years, but is countered by an increase in wall thickness, resulting in an altered shape but no change in overall LV mass. In men, the length reduction is about 11% over the same time interval. However, wall thickness in men does not increase

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This study was supported by Grant 1R01 HL46223 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland.

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