Background: Epidemiologic studies suggest that women are at increased risk of developing heart failure secondary to hypertension. Other studies have documented sex differences in left ventricular systolic and diastoli...Background: Epidemiologic studies suggest that women are at increased risk of developing heart failure secondary to hypertension. Other studies have documented sex differences in left ventricular systolic and diastolic function in the presence of pressure overload states such as seen in aortic stenosis and hypertension. It is less clear if sex differences are present among older persons with mild hypertension. Methods: One hundred seven healthy subjects, aged 55 to 75 years,with blood pressures ranging from 130 to 159 mmHg systolic and/or 85 to 99 mmHg diastolic, were examined by standard echocardiography and the newer modalities of tissue Doppler and color M-mode imaging. Results: Women had a lower peak mitral annular systolic velocity(Sm), 8.9(95% CI 8.4- 9.5)cm/s versus 10.2(95% CI 9.6- 11.0)cm/s,(P< .01)than men. Among women, increasing age was associated with a reduction in diastolic function. For every decade of age, peak early mitral annular diastolic velocity(Em)declined by 1.6 cm/s(P< .01), mitral inflow velocity of propagation(Vp)declined by 26% (P< .01), E/Vp ratio increased by 20% (P=.03), and E/Em ratio increased by 11% (P=.04)in women. No age-associated changes were seen in men. Conclusions: As revealed by newer echocardiographic imaging modalities, women with mild hypertension showed greater reductions in systolic and diastolic function as they aged compared with men. Our findings are consistent with the increased risk older women have of developing heart failure because of hypertension.展开更多
Background: The mechanisms responsible for impaired cardiovascular hemodynamics during exercise among persons with milder forms of hypertension are not well documented. We examined the relationship of oxygen pulse dur...Background: The mechanisms responsible for impaired cardiovascular hemodynamics during exercise among persons with milder forms of hypertension are not well documented. We examined the relationship of oxygen pulse during exercise, a correlate of stroke volume, with echocardiographic indices of resting left ventricular function to determine whether abnormal contractility and relaxation are related to abnormal cardiovascular dynamics during exercise among such persons. Methods: Subjects were 44 men and 55 women ages 55 to 75 years with mild hypertension but who were otherwise healthy. Resting left ventricular systolic and diastolic functions were assessed with 2-dimensional Doppler echocardiography and tissue Doppler imaging. Oxygen pulse(millimeters per beat)at rest and during multistage treadmill testing was derived from measurements of oxygen consumption and heart rate. The slope of oxygen pulse between successive exercise stages was calculated. Results: After a steep rise in oxygen pulse from rest to stage 1 of exercise, a markedly diminished oxygen pulse slope was seen between subsequent exercise stages. In stepwise regression analysis, the increase in the slope of oxygen pulse from rest to stage 1 was explained by a greater lean body mass(57% , P< .001)and a larger left atrial size(2% , P< .001). After exercise stage 1, the increase in the slope of oxygen pulse was explained by sex(24% , P< .001), higher mitral E/A ratio(6% , P< .001), and higher mitral annular systolic velocity(6% , P< .001). Conclusions: These results suggest that a blunted oxygen pulse response to exercise among older persons with milder forms of hypertension may reflect impaired left ventricular stroke volume changes during exercise secondary to subtle abnormalities in both systolic and diastolic left ventricular functions.展开更多
文摘Background: Epidemiologic studies suggest that women are at increased risk of developing heart failure secondary to hypertension. Other studies have documented sex differences in left ventricular systolic and diastolic function in the presence of pressure overload states such as seen in aortic stenosis and hypertension. It is less clear if sex differences are present among older persons with mild hypertension. Methods: One hundred seven healthy subjects, aged 55 to 75 years,with blood pressures ranging from 130 to 159 mmHg systolic and/or 85 to 99 mmHg diastolic, were examined by standard echocardiography and the newer modalities of tissue Doppler and color M-mode imaging. Results: Women had a lower peak mitral annular systolic velocity(Sm), 8.9(95% CI 8.4- 9.5)cm/s versus 10.2(95% CI 9.6- 11.0)cm/s,(P< .01)than men. Among women, increasing age was associated with a reduction in diastolic function. For every decade of age, peak early mitral annular diastolic velocity(Em)declined by 1.6 cm/s(P< .01), mitral inflow velocity of propagation(Vp)declined by 26% (P< .01), E/Vp ratio increased by 20% (P=.03), and E/Em ratio increased by 11% (P=.04)in women. No age-associated changes were seen in men. Conclusions: As revealed by newer echocardiographic imaging modalities, women with mild hypertension showed greater reductions in systolic and diastolic function as they aged compared with men. Our findings are consistent with the increased risk older women have of developing heart failure because of hypertension.
文摘Background: The mechanisms responsible for impaired cardiovascular hemodynamics during exercise among persons with milder forms of hypertension are not well documented. We examined the relationship of oxygen pulse during exercise, a correlate of stroke volume, with echocardiographic indices of resting left ventricular function to determine whether abnormal contractility and relaxation are related to abnormal cardiovascular dynamics during exercise among such persons. Methods: Subjects were 44 men and 55 women ages 55 to 75 years with mild hypertension but who were otherwise healthy. Resting left ventricular systolic and diastolic functions were assessed with 2-dimensional Doppler echocardiography and tissue Doppler imaging. Oxygen pulse(millimeters per beat)at rest and during multistage treadmill testing was derived from measurements of oxygen consumption and heart rate. The slope of oxygen pulse between successive exercise stages was calculated. Results: After a steep rise in oxygen pulse from rest to stage 1 of exercise, a markedly diminished oxygen pulse slope was seen between subsequent exercise stages. In stepwise regression analysis, the increase in the slope of oxygen pulse from rest to stage 1 was explained by a greater lean body mass(57% , P< .001)and a larger left atrial size(2% , P< .001). After exercise stage 1, the increase in the slope of oxygen pulse was explained by sex(24% , P< .001), higher mitral E/A ratio(6% , P< .001), and higher mitral annular systolic velocity(6% , P< .001). Conclusions: These results suggest that a blunted oxygen pulse response to exercise among older persons with milder forms of hypertension may reflect impaired left ventricular stroke volume changes during exercise secondary to subtle abnormalities in both systolic and diastolic left ventricular functions.
