title: Impact of chronic changes in arterial compliance and resistance on left ventricular ageing in humans.
abstract: OBJECTIVE
  Left ventricular systolic elastance (Ees) and diastolic elastance (Eed) correlate with arterial elastance (Ea), but it is unknown how chronic changes in arterial compliance and resistance, which determine Ea, might differentially affect cardiac properties with ageing. We sought to characterize chronic changes in pulsatile and resistive arterial load and correlate them with longitudinal changes in LV structure and function in a prospective, community-based study.
  
  
  RESULTS
  Comprehensive echocardiography was performed in 722 subjects participating in a randomly selected community-based study at two examinations separated by 4 years, allowing for assessment of LV Ees, Eed, and end-diastolic volume (EDV), Ea, total arterial compliance, and systemic vascular resistance at both examinations. Chronic changes in resistance and heart rate were the dominant contributors to change in Ea. Changes in arterial compliance had little impact on changes in Ea, but were strongly associated with changes in Ees. The combination of increased resistance and decreased compliance was associated with the largest increase in LV diastolic stiffness, an effect that was mediated by a decrease in LVEDV. In contrast, subjects with both improved arterial compliance and decreased resistance displayed an increase in LVEDV over time, with no increase in LV Eed.
  
  
  CONCLUSIONS
  Increases in pulsatile arterial load with ageing contribute more to LV systolic stiffening, while combined pulsatile and resistive loading changes are associated with positive and negative chamber remodelling and diastolic stiffness. Therapies designed to improve arterial resistance and particularly to enhance aortic compliance may hold promise to prevent or reverse cardiac ageing and its sequelae.
authors.affiliation: Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic Rochester, Rochester, MN, USA; International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic; Center for Cardiovascular Prevention of the First Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czech Republic; Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine- IKEM, Prague, Czech Republic.
authors.forename: Peter
authors.initials: P
authors.lastname: Wohlfahrt
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Redfield
authors.forename: Vojtech
authors.initials: V
authors.lastname: Melenovsky
authors.forename: Francisco
authors.initials: F
authors.lastname: Lopez-Jimenez
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Rodeheffer
authors.forename: Barry A
authors.initials: BA
authors.lastname: Borlaug
mesh_terms: D000368:Aged; D000375:Aging / Q000502:physiology*; D001158:Arteries / Q000502:physiology*; D003187:Compliance / Q000502:physiology; D004452:Echocardiography; D004548:Elasticity; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014655:Vascular Resistance / Q000502:physiology*; D059289:Vascular Stiffness / Q000502:physiology; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Ageing; Arterial compliance; Arterial resistance; Heart failure; Heart failure with preserved ejection fraction; Left ventricular stiffness