title: Prevalence, clinical correlates, and functional impact of subaortic ventricular septal bulge (from the Baltimore Longitudinal Study of Aging).
abstract: A localized hypertrophy of the subaortic segment of the ventricular septum-ventricular septal bulge (VSB)-has been frequently described in series of elderly population, but its prevalence with age, clinical correlates, and impact on cardiac function and exercise capacity remain uncertain. We explored these associations in a cross-sectional sample without known cardiac disease from the Baltimore Longitudinal Study of Aging. We randomly selected 700 participants (50% men, mean age 64 ± 15, range 26 to 95 years) and reviewed their echocardiograms. We identified 28 men and 21 women with VSB (7% overall prevalence). The prevalence of VSB significantly increased with age in both genders (p <0.0001). In multivariate logistic regression including hypertension and other cardiovascular risk factors, only age displayed a significant independent association with VSB (OR 1.06 per year, 95% confidence interval 1.03 to 1.10, p = 0.0001). After multiple adjustments, participants with VSB compared with those without had enhanced global left ventricular contractility (fractional shortening 41 ± 1.3 vs 38 ± 0.3%, p = 0.04; ejection fraction 71 ± 1.6 vs 67 ± 0.4%, p = 0.06; systolic velocity of the mitral annulus 8.4 ± 0.1 vs 8.9 ± 0.3, p = 0.06), and larger aortic root diameters (3.3 ± 0.06 vs 3.1 ± 0.02 cm, p = 0.02). In subgroup of participants who completed a maximal treadmill test (177 women and 196 men), those with VSB (19, 5.1%) had significantly lower peak oxygen consumption than their counterparts (19.6 ± 3.8 vs 22.9 ± 6.6 ml/kg/min, p = 0.03). However, this association was no longer significant after multiple adjustments. In conclusion, the presence of VSB is independently associated with older age and determines enhanced left ventricular contractility, without any evident impact on exercise capacity.
authors.affiliation: Longitudinal Studies Section, Translational Gerontology Branch, NIA/NIH, Baltimore, Maryland; Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute on Aging/National Institute of Health, Baltimore, Maryland; Division of Cardiology, Johns Hopkins University, Baltimore, Maryland; Department of Internal Medicine, University of Genova, Genova, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Canepa
authors.affiliation: Longitudinal Studies Section, Translational Gerontology Branch, NIA/NIH, Baltimore, Maryland; Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute on Aging/National Institute of Health, Baltimore, Maryland.
authors.forename: Omar
authors.initials: O
authors.lastname: Malti
authors.affiliation: Longitudinal Studies Section, Translational Gerontology Branch, NIA/NIH, Baltimore, Maryland; Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute on Aging/National Institute of Health, Baltimore, Maryland; MedStar Health Research Institute, Washington, District of Columbia.
authors.forename: Melissa
authors.initials: M
authors.lastname: David
authors.affiliation: Longitudinal Studies Section, Translational Gerontology Branch, NIA/NIH, Baltimore, Maryland; Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute on Aging/National Institute of Health, Baltimore, Maryland; Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
authors.forename: Majd
authors.initials: M
authors.lastname: AlGhatrif
authors.affiliation: Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute on Aging/National Institute of Health, Baltimore, Maryland.
authors.forename: James B
authors.initials: JB
authors.lastname: Strait
authors.affiliation: Department of Internal Medicine, University of Genova, Genova, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Ameri
authors.affiliation: Department of Internal Medicine, University of Genova, Genova, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Brunelli
authors.affiliation: Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute on Aging/National Institute of Health, Baltimore, Maryland.
authors.forename: Edward G
authors.initials: EG
authors.lastname: Lakatta
authors.affiliation: Longitudinal Studies Section, Translational Gerontology Branch, NIA/NIH, Baltimore, Maryland.
authors.forename: Luigi
authors.initials: L
authors.lastname: Ferrucci
authors.affiliation: Division of Cardiology, Johns Hopkins University, Baltimore, Maryland. Electronic address: tabraha3@jhmi.edu.
authors.forename: Theodore P
authors.initials: TP
authors.lastname: Abraham
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015142:Baltimore / Q000453:epidemiology; D004452:Echocardiography; D017079:Exercise Tolerance; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*