Division of cardiology, Johns Hopkins University, School of Medicine.
Background: The importance of aorta-ventricular coupling in cardiovascular disease is recognized but underestimated. The contribution of the age-related decline in ascending aortic function in comparison to characteristic impedance and total peripheral resistance on left ventricular function and remodeling is poorly studied. Our aim was to evaluate the relation of proximal aortic distensibility and impedance with left ventricular geometry and function in asymptomatic individuals.
Methods And Results: We prospectively studied 100 subjects (47 men, 53 women, age: 20-84 years). Aortic strain, distensibility, arch pulse wave velocity, characteristic impedance (Zc), total peripheral resistance (TPR), LV volumes and mass, wall stress, peak global circumferential myocardial strain and strain rates were determined by magnetic resonance imaging (MRI). Central pressures were measured from tonometry. Ea/Ees, an index of vascular-ventricular coupling, and LV wall stress were preserved across age or aortic stiffness stratified groups. Static and pulsatile components of aortic load were differentially associated with age. Increased TVR was associated with decreased LV strain and increased concentric remodeling (M/V ratio) in all individuals. In younger individuals (<45 yrs), aortic distensibility was related to LV strain and concentric remodeling (M/V ratio) whereas Zc was related to LV strain and concentric remodeling (M/V ratio) in older individuals (>45 yrs).
Conclusions: Early age-related stiffening of the ascending aorta is a component of LV afterload subsequently associated with increased aortic impedance and alterations in LV geometry, namely concentric remodeling, decreased myocardial strain and increased stroke work such that LV wall stress and arterial-ventricular coupling are preserved.
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