Age-related changes in intraventricular kinetic energy: a physiological or pathological adaptation?

James Wong, Radomir Chabiniok, Adelaide deVecchi, Nathalie Dedieu, Eva Sammut, Tobias Schaeffter, Reza Razavi, James Wong, Radomir Chabiniok, Adelaide deVecchi, Nathalie Dedieu, Eva Sammut, Tobias Schaeffter, Reza Razavi

Abstract

Aging has important deleterious effects on the cardiovascular system. We sought to compare intraventricular kinetic energy (KE) in healthy subjects of varying ages with subjects with ventricular dysfunction to understand if changes in energetic momentum may predispose individuals to heart failure. Four-dimensional flow MRI was acquired in 35 healthy subjects (age: 1-67 yr) and 10 patients with left ventricular (LV) dysfunction (age: 28-79 yr). Healthy subjects were divided into age quartiles (1st quartile: <16 yr, 2nd quartile: 17-32 yr, 3rd quartile: 33-48 yr, and 4th quartile: 49-64 yr). KE was measured in the LV throughout the cardiac cycle and indexed to ventricular volume. In healthy subjects, two large peaks corresponding to systole and early diastole occurred during the cardiac cycle. A third smaller peak was seen during late diastole in eight adults. Systolic KE (P = 0.182) and ejection fraction (P = 0.921) were preserved through all age groups. Older adults showed a lower early peak diastolic KE compared with children (P < 0.0001) and young adults (P = 0.025). Subjects with LV dysfunction had reduced ejection fraction (P < 0.001) and compared with older healthy adults exhibited a similar early peak diastolic KE (P = 0.142) but with the addition of an elevated KE in diastasis (P = 0.029). In healthy individuals, peak diastolic KE progressively decreases with age, whereas systolic peaks remain constant. Peak diastolic KE in the oldest subjects is comparable to those with LV dysfunction. Unique age-related changes in ventricular diastolic energetics might be physiological or herald subclinical pathology.

Keywords: cardiac function; cardiovascular magnetic resonance; energy; four-dimensional phase-contrast magnetic resonance imaging; heart failure.

Copyright © 2016 the American Physiological Society.

Figures

Fig. 1.
Fig. 1.
Illustrative example of two-, three-, and four-chamber views of a healthy heart demonstrating kinetic energy (KE) density during different portions of the cardiac cycle.
Fig. 2.
Fig. 2.
KE in the left ventricle (LV) according to age. These images show KE indexed to the ventricular volume at each time point during the cardiac cycle. Indexing KE to the volume of blood at that time allowed comparison between subjects of different sizes. The cardiac cycle was divided into fractions of the R-R interval. Top left: 1st age quartile; top right: 2nd age quartile; bottom left: 3rd age quartile; bottom right: 4th age quartile.
Fig. 3.
Fig. 3.
Peak KE in systole (A) and early diastole (B) for the healthy LV against age. With aging, systolic KE had a mildly positive correlation, whereas diastolic KE had a moderate negative correlation.
Fig. 4.
Fig. 4.
Box and whisker plot of early diastolic KE against age quartile in healthy subjects. Diastolic KE was significantly lower in older adults from the 4th age quartile than children in the 1st age quartile and young adults in the 2nd age quartile.
Fig. 5.
Fig. 5.
Correlation of mitral valve E wave velocity with peak early diastolic KE (A) and age (B). There was a moderate correlation between mitral valve E wave velocities and diastolic KE.
Fig. 6.
Fig. 6.
Mean KE of 4th quartile (oldest) adults compared with subjects with LV dysfunction. Subjects with LV dysfunction had KE profiles with a similar diastolic KE peak compared with older adults but with additional changes including a lower systolic KE peak and a higher KE in diastasis.
Fig. 7.
Fig. 7.
Changes in peak KE during systole and early diastole for subjects with LV dysfunction compared with age- and sex-matched healthy control subjects. The origin point was used as the index for all healthy control subjects. The arrows demonstrate the change in KE for the matched LV dysfunction subjects. Values below the origin represent a decrease in peak early diastolic KE for LV dysfunction subjects compared with healthy control subjects, whereas values to the left of the origin represent a decrease in peak systolic KE.

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Source: PubMed

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