Diastolic left ventricular filling in 50-year-old male and female adults : Evaluation by Doppler echocardiography

Abstract: Left ventricular (LV) diastolic filling abnormalities are seen in many patients with various cardiac disorders. Age is an important determinant of Doppler indices of LV diastolic filling. To define reference values and analyse factors of importance to Doppler indices of LV filling in subjects of similar age, 273 persons (161 women and 112 men) aged 50 years underwent Doppler echocardiography. The subjects originated from an epidemiologic study on the prevalence of chest pain in 50-year-old subjects in the county of Västmanland, Sweden: 141 subjects were free of chest pain and 132 had a history of chest pain. The following Doppler indices of LV filling were studied: peak early diastolic velocity (E-wave), peak atrial diastolic velocity (A-wave), early to atrial peak velocity ratio (E/A) and deceleration time of early velocity. There was a wide variation in the peak early velocity E, the peak atrial velocity A, the E/A ratio and the deceleration time of early velocity in 134 healthy 50-year-old persons without chest pain. Peak early diastolic velocity E (0.75 ± 0.11 m/s vs 0.66 ± 0.10 m/s; p<0.001) and the E/A ratio (1.24 ± 0.25 vs 1.14 ± 0.20; p<0.05) were greater in women than men. Heart rate, body mass index, diastolic blood pressure, gender and LV internal dimension explained 43% of the variation in the E/A ratio in the healthy subjects. We investigated 77 of the healthy persons with Doppler echocardiography after exercise testing. There was a physiological decrease in the E/A ratio 15 minutes after exercise in both women and men, and Doppler diastolic indices after exercise were strongly dated with diastolic indices at rest and with heart rate. The carotid arterial distensibility coefficient, an indicator of large arterial distensibility, was significantly associated with the E/A ratio (p<0.005) in a multivariate analysis of 237 50-year-old persons with and without chest pain, suggesting that arterial distensibility may have an effect on LV diastolic filling or that changes in the arterial elastic properties are associated with corresponding structural changes of the left ventricle. The E/A ratio was lower in the 26 hypertensive 50-year-old persons we studied, compared with the E/A ratio in the healthy persons aged 50 years. LV diameter, body mass index and gender were determinants of Doppler indices of LV, filling in 50-year-old hypertensive persons. The influence of menopause on diastolic LV Doppler indices was analysed in 121 women. Peek early diastolic velocity E (0.80 ± 0.13 m/s vs 0.73 ± 0.10 m/s; p<0.01) and the E/A ratio (1.26 ± 0.23 vs 1.15 ± 0.25; p<0.05) were greater in premenopausal than postmenopausal women, and menopause was independently associated with the E/A ratio, suggesting impaired LV diastolic filling in postmenopausal women. In conclusion, Doppler measurements of LV diastolic filling showed a wide variation in healthy personsaged 50 years. The E/A ratio was significantly associated with gender, heart rate, body mass index, diastolic blood pressure, LV dimension, carotid arterial distensibility and menopause in 50-year-old subjects.