title: Age- and Sex-Related Influences on Left Ventricular Mechanics in Elderly Individuals Free of Prevalent Heart Failure: The ARIC Study (Atherosclerosis Risk in Communities).
abstract: BACKGROUND
  Advanced age is related to left ventricular (LV) remodeling. We sought to investigate the relationships between aging, elevated hemodynamic load, cardiac mechanics, and LV remodeling in an elderly community-based population.
  
  
  RESULTS
  We studied 1105 subjects (76±5 years, 61% women) without prevalent heart failure, who attended the visit 5 of the ARIC study (Atherosclerosis Risk in Communities). LV global longitudinal strain, global circumferential strain, and torsion indices were analyzed using 3-dimensional echocardiography. Advanced age was associated with greater LV concentricity, lower myocardial diastolic relaxation, reduced global longitudinal strain (adjusted estimate, 0.39±0.19% (SE)/decade; P=0.038), borderline greater global circumferential strain (adjusted estimate, -0.59±0.36% (SE)/decade; P=0.08), and higher torsion indices (adjusted estimate for torsion, 0.33±0.04° (SE)/decade; P<0.001). In addition, greater concentricity was associated with decreased global longitudinal strain and greater torsion in multivariable models (all P<0.001). Women showed smaller LV cavity size, greater concentricity, lower myocardial relaxation velocity E', though demonstrated greater global longitudinal strain, global circumferential strain, and torsion than men (all P<0.05). Overall, subjects with hypertension and increasing age were more likely to have higher torsion, though the association between advanced age and greater torsion was more pronounced in women than in men (both interaction P<0.05).
  
  
  CONCLUSIONS
  In an asymptomatic, senescent community-dwelling population, we observed a distinct, sex-specific pattern of cardiac remodeling. Although we observed worse diastolic and longitudinal function with advanced age or elevated load in both sexes, a significant increase of torsion was more pronounced in women.
authors.affiliation: From the Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan (C.-L.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.-L.H., A.G., A.M.S., S.C., S.D.S.); Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Physiology, University of Porto Medical School, Portugal (A.G.); and Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.K.).
authors.forename: Chung-Lieh
authors.initials: CL
authors.lastname: Hung
authors.affiliation: From the Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan (C.-L.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.-L.H., A.G., A.M.S., S.C., S.D.S.); Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Physiology, University of Porto Medical School, Portugal (A.G.); and Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.K.).
authors.forename: Alexandra
authors.initials: A
authors.lastname: Gonçalves
authors.affiliation: From the Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan (C.-L.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.-L.H., A.G., A.M.S., S.C., S.D.S.); Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Physiology, University of Porto Medical School, Portugal (A.G.); and Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.K.).
authors.forename: Amil M
authors.initials: AM
authors.lastname: Shah
authors.affiliation: From the Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan (C.-L.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.-L.H., A.G., A.M.S., S.C., S.D.S.); Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Physiology, University of Porto Medical School, Portugal (A.G.); and Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.K.).
authors.forename: Susan
authors.initials: S
authors.lastname: Cheng
authors.affiliation: From the Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan (C.-L.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.-L.H., A.G., A.M.S., S.C., S.D.S.); Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Physiology, University of Porto Medical School, Portugal (A.G.); and Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.K.).
authors.forename: Dalane
authors.initials: D
authors.lastname: Kitzman
authors.affiliation: From the Department of Medicine, MacKay Medical College, New Taipei City 252, Taiwan (C.-L.H.); Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.-L.H., A.G., A.M.S., S.C., S.D.S.); Division of Cardiology, Departments of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan (C.-L.H.); Department of Physiology, University of Porto Medical School, Portugal (A.G.); and Section of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.K.). ssolomon@rics.bwh.harvard.edu.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D001696:Biomechanical Phenomena; D003430:Cross-Sectional Studies; D003971:Diastole; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology; D008297:Male; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D054159:Torsion, Mechanical; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
keywords: atherosclerosis; blood pressure; heart failure; hypertension; stroke volume