03702nas a2200409 4500008004100000022001400041245015600055210006900211260001600280300001200296490000700308520256000315653001602875653000902891653002202900653001002922653001902932653002102951653002102972653001102993653001103004653003403015653000903049653001603058653001203074100001603086700001703102700002003119700001603139700001603155700002303171700001703194700001303211700001503224700001703239856003603256 1995 eng d a0009-732200aSex, age, and disease affect echocardiographic left ventricular mass and systolic function in the free-living elderly. The Cardiovascular Health Study.0 aSex age and disease affect echocardiographic left ventricular ma c1995 Mar 15 a1739-480 v913 a

BACKGROUND: Left ventricular (LV) hypertrophy, as measured by M-mode echocardiography, is an independent predictor of mortality and/or morbidity from coronary heart disease (CHD). LV global and segmental systolic dysfunction also have been associated with myocardial ischemia and cardiovascular morbidity and mortality. Echocardiographic data, especially two-dimensional, have not been available previously from multicenter-based studies of the elderly. This report describes the distribution and relation at baseline of echocardiographic LV mass and global and segmental LV wall motion to age, sex, and clinical disease category in the Cardiovascular Health Study (CHS), a cohort of 5201 men and women (4850 white) 65 years of age and older.

METHODS AND RESULTS: M-mode LV mass adjusted for body weight increased modestly with age (P < .0001), increasing less than one gram per year increase in age for both men and women. After adjustment for weight, LV mass was significantly greater in men than in women and in participants with clinical CHD compared with participants with neither clinical heart disease nor hypertension (both P < .001). Across all CHS age subgroups, the difference in weight-adjusted LV mass by sex was greater in magnitude than the difference related to clinical CHD. M-mode measurements of LV mass could not be made in 34% of CHS participants, and this was highly related to age (29% in the 65 to 69 year versus 50% in the 85+ year age group, P < .001) and other risk factors. In participants with clinical CHD and with neither clinical heart disease nor hypertension, LV ejection fraction and segmental wall motion abnormalities were more prevalent in men than women (all P < .001). Of interest, 0.5% of men and 0.4% of women with neither clinical heart disease nor hypertension had LV segmental wall motion abnormalities, suggesting silent disease, compared with 26% of men and 10% of women in the clinical CHD group (P < .0001). Multivariate analyses revealed male sex and presence of clinical CHD (both P < .001) to be independent predictors of LV akinesis or dyskinesis.

CONCLUSIONS: Significant baseline relations were detected between differences in sex, prevalent disease status, and echocardiographic measurements of LV mass and systolic function in the CHS cohort. Age was weakly associated with LV mass measurements and LV ejection fraction abnormalities. These relations should be considered in evaluating the preclinical and clinical effects of CHD risk factors in the elderly.

10aAge Factors10aAged10aAged, 80 and over10aAging10aCohort Studies10aCoronary Disease10aEchocardiography10aFemale10aHumans10aHypertrophy, Left Ventricular10aMale10aSex Factors10aSystole1 aGardin, J M1 aSiscovick, D1 aAnton-Culver, H1 aLynch, J, C1 aSmith, V, E1 aKlopfenstein, H, S1 aBommer, W, J1 aFried, L1 aO'Leary, D1 aManolio, T A uhttps://chs-nhlbi.org/node/142203691nas a2200409 4500008004100000022001400041245007500055210006900130260001300199300001300212490000700225520259400232653000902826653002202835653001902857653001602876653002802892653001902920653002102939653001102960653001102971653003402982653000903016653002403025653001703049653003103066100001603097700001403113700002003127700001503147700001503162700002303177700001703200700001303217700001503230856003603245 1997 eng d a0194-911X00aLeft ventricular mass in the elderly. The Cardiovascular Health Study.0 aLeft ventricular mass in the elderly The Cardiovascular Health S c1997 May a1095-1030 v293 a

Left ventricular (LV) mass, as estimated from M-mode echocardiography (echo), has previously been shown to be an independent predictor of incident cardiovascular disease morbidity and mortality. We evaluated the relationship at baseline of echo LV mass to relevant cardiovascular disease risk factors and other potential covariates in the Cardiovascular Health Study, multicenter study sponsored by the National Heart, Lung, and Blood Institute of 5201 men and women aged 65 years or older (mean, 73). Two-dimensionally directed M-mode echo LV mass measurements could be obtained in 1357 men and 2053 women (66% of this elderly cohort). Stepwise linear regression analyses of the relationship of echo LV mass to demographic and risk factor, physical activity, electrocardiographic, and prevalent disease variables resulted in a model that explained 37% of the variance for the entire cohort. In order of decreasing importance, factors positively associated with echo LV mass were body weight, male sex, systolic pressure, presence of congestive heart failure, present smoking, major and minor electrocardiographic abnormalities, treatment for hypertension, valvular heart disease, aortic regurgitation by color Doppler, and mitral regurgitation by color Doppler (in men) whereas diastolic pressure, bioresistance (a measure of adiposity), and high-density lipoprotein cholesterol were inversely related to echo LV mass. Although height and weight were both related to LV mass, height added nothing once weight was entered in multiple linear regression analyses. Furthermore, in the multiple regression models, diastolic pressure was inversely and systolic BP positively related to LV mass, with similar magnitudes for their coefficients. In consonance with these findings, pulse pressure was positively related to LV mass in bivariate analyses. Multiple linear regression analyses explained less of the variance for ventricular septal thickness (R2 = .13) and LV posterior wall thickness (R2 = .14) than for LV mass (R2 = .37) and LV diastolic dimension (R2 = .27). Intriguing findings in the elderly Cardiovascular Health Study cohort included the presence of pulse pressure as a positive correlate, and high-density lipoprotein cholesterol as an inverse correlate, of LV mass. Longitudinal studies in the Cardiovascular Health Study cohort will help to clarify the importance of demographic, risk factor, and other variables, and changes in these variables, in predicting changes in echo LV mass and its components as well as the prognostic significance of LV mass in the elderly.

10aAged10aAged, 80 and over10aBlood Pressure10aBody Weight10aCardiovascular Diseases10aCohort Studies10aEchocardiography10aFemale10aHumans10aHypertrophy, Left Ventricular10aMale10aProspective Studies10aRisk Factors10aVentricular Function, Left1 aGardin, J M1 aArnold, A1 aGottdiener, J S1 aWong, N, D1 aFried, L P1 aKlopfenstein, H, S1 aO'Leary, D H1 aTracy, R1 aKronmal, R uhttps://chs-nhlbi.org/node/148003226nas a2200397 4500008004100000022001400041245008800055210006900143260001600212300001100228490000700239520213100246653000902377653002202386653002502408653002402433653002802457653001902485653001302504653003002517653002402547653001102571653001802582653002102600653001102621653000902632653003102641100001602672700001702688700001502705700001602720700001502736700002302751700001802774856003602792 1998 eng d a0002-914900aLeft ventricular diastolic filling in the elderly: the cardiovascular health study.0 aLeft ventricular diastolic filling in the elderly the cardiovasc c1998 Aug 01 a345-510 v823 a

Changes in left ventricular (LV) diastolic function (e.g., as measured by transmitral flow velocity) are known to occur with aging. In addition, impaired LV diastolic function plays an important role in such cardiovascular disorders common in the elderly as hypertension, ischemic heart disease, and congestive heart failure (CHF). Participants in the Cardiovascular Health Study, a multicenter study of community-dwelling men (n=2,239) and women (n=2,962) > or = 65 years of age, underwent an extensive baseline evaluation, including echocardiography. Early diastolic LV Doppler (transmitral) peak filling velocity decreased, and peak late diastolic (atrial) velocity increased with age in multivariate analyses (all p <0.001). Early and late diastolic peak filling velocities were both significantly higher in women than in men, even after adjustment for body surface area (or height and weight). In multivariate models in the entire cohort and a healthy subgroup (n=703), gender, age, heart rate, and blood pressure (BP) were most strongly related to early and late diastolic transmitral peak velocities. Early and late diastolic peak velocities both increased with increases in systolic BP and decreased with increases in diastolic BP (p <0.001). Doppler transmitral velocities were compared among health status subgroups. In multiple regression models adjusted for other covariates, and in analysis of variance models examining differences across subgroups adjusted only for age, the subgroup with CHF had the highest early diastolic peak velocities. All clinical disease subgroups had higher late diastolic peak velocities than the healthy subgroup, with the subgroups with either CHF or hypertension having the highest age-adjusted means. The subgroup with hypertension had the lowest ratio of early-to-late diastolic peak velocity, and men with CHF had the highest ratio. These findings are consistent with previous reports that hypertensive subjects exhibit an abnormal relaxation pattern, whereas patients with CHF develop a pattern suggestive of an increased early diastolic left atrial-LV pressure gradient.

10aAged10aAged, 80 and over10aAnalysis of Variance10aBlood Flow Velocity10aCardiovascular Diseases10aCohort Studies10aDiastole10aEchocardiography, Doppler10aElectrocardiography10aFemale10aHealth Status10aHeart Ventricles10aHumans10aMale10aVentricular Function, Left1 aGardin, J M1 aArnold, A, M1 aBild, D, E1 aSmith, V, E1 aLima, J, A1 aKlopfenstein, H, S1 aKitzman, D, W uhttps://chs-nhlbi.org/node/1510