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European Journal of Echocardiography 2008 9(2):241-249; doi:10.1016/j.euje.2007.03.044
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2007. For permissions please email: journals.permissions@oxfordjournals.org

The impact of aging on left ventricular longitudinal function in healthy subjects: a pulsed tissue Doppler study

Pasquale Innelli, Ruben Sanchez, Francesco Marra, Roberta Esposito and Maurizio Galderisi*

Division of Cardioangiology with CCU, Department of Clinical and Experimental Medicine, Federico II University Hospital, Block 1, Via S. Pansini 5, 80131 Naples, Italy

Received 17 March 2007; accepted after revision 25 March 2007; online publish-ahead-of-print 25 June 2007.

* Corresponding author. Tel: +39 081 746 2145; fax: +39 081 546 6152. E-mail address: mgalderi{at}unina.it(M. Galderisi).


   Abstract
Top
 Abstract
Introduction
 Methods
 Results
 Univariate relations of tissue...
 Discussion
 References
 
Aims: To evaluate the influence of age on average values of pulsed tissue Doppler recorded at the septal and lateral mitral annulus in a population of healthy subjects and to propose reference values according to different age decades.

Methods and results: Two hundred and forty-six healthy subjects (M/F = 160/86, mean age 40.9 years) underwent Doppler-echocardiography and pulsed tissue Doppler of the septal and lateral mitral annulus. Sm, Em, Am peak velocities were measured at both the annular sides and average values obtained. The ratio of transmitral E peak velocity and average Em peak velocity (lateral Em + septal Em/2) was calculated as an index of left ventricular filling pressure. The population was divided into seven age decades: 10–19, 20–29, 30–39, 40–49, 50–59, 60–69 years and >70 years. Em was progressively reduced and Am increased with increasing age at both the annular sides as well as average values. Sm reduction with advancing age was significant only at the lateral mitral annulus and as average values. Average E/Em ratio was particularly higher in the last three age decades. By multilinear regression analyses, age was the main independent predictor of average Em, Am and E/Em ratio, while heart rate was the most important contributor to average Sm, with the additional contribution of age.

Conclusions: Aging shows an independent impact on average tissue Doppler indexes of septal and lateral mitral annulus in normal subjects. Our data also provide reference values of tissue Doppler average variables for age decades.

Keywords: Aging; Pulsed tissue Doppler; Doppler echocardiography; Left ventricular function; Left ventricular filling pressure


   Introduction
Top
 Abstract
 Introduction
Methods
 Results
 Univariate relations of tissue...
 Discussion
 References
 
Pulsed tissue Doppler is an ultrasound tool that provides quantification of longitudinal myocardial function with high feasibility and reproducibility.1–4 Because of its relative independence on preload effect,5,6 tissue Doppler derived myocardial early diastolic velocity (Em) appears as a reliable index of myocardial relaxation, it being significantly correlated with tau, the constant of isovolumic relaxation measured by cardiac catheterization.5–8 While some authors assessed tissue Doppler derived diastolic parameters at the level of the septal mitral annulus,6 others preferred to measure the same variables at the lateral mitral annulus.2 The use of septal annulus by tissue Doppler tends to overestimate the severity of left ventricular myocardial diastolic dysfunction in comparison with the use of the lateral annulus.9 In this view, the average of both septal and lateral annular values have been suggested to obtain a more comprehensive evaluation of myocardial diastolic function.5,8,10 By combining the preload dependent transmitral early diastolic velocity with the load independent average Em (septal + lateral value/2) of the mitral annulus, i.e. the E/Em ratio, we can obtain an index which has been demonstrated to be more feasible and accurate than pulmonary vein flow velocity pattern and Valsalva maneuver applied to transmitral inflow in estimating the degree of left ventricular filling pressure.10 The E/Em ratio is a reliable expression of left ventricular filling pressure in patients with both diastolic and systolic heart failure.11 On the other hand, myocardial systolic velocity (Sm) of the mitral annulus is an important measurement of LV longitudinal systolic function,12 its amplitude being strongly reduced in patients with severe heart failure13 and idiopathic dilated cardiomyopathy.14 It is worthy of note that both Em and Sm velocities have shown independent prognostic value in the clinical setting.15,16

Previous authors assessed the influence of aging on pulsed tissue Doppler derived diastolic parameters of LV mitral annulus by recording lateral Em17–19 and/or septal Em.18–21 The relation of E/Em ratio with age was also evaluated in four of these studies.17,18,20,21 However, little information is available about the impact of aging on myocardial velocities by averaging the values of septal and lateral annulus. The present study aimed to evaluate the influence of age on average values of pulsed tissue Doppler derived measurements of systolic and diastolic function in a population of healthy subjects, in relation to demographic and echocardiographic variables, and to propose reference values according to different age decades.


   Methods
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 Abstract
 Introduction
 Methods
Results
 Univariate relations of tissue...
 Discussion
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Study population
We studied 246 healthy subjects (160 men and 86 women, mean age 40.9 ± 18.3 years, age range 10–82 years) referred to our echo-lab, recruited from the staff and relatives of our department. No subject had a history of cardiovascular disease including arterial hypertension, diabetes mellitus, coronary artery disease and previous acutemyocardial infarction, stroke and transient ischemic events, significant valvular heart disease, or congestive heart failure. Other exclusion criteria concerned age <10 years, overweight (body mass index >25.9 kg/m2), dyslipidemia (total cholesterol >190 mg/dL and triglycerides >150 mg/dL) and any kind of resting ECG abnormalities. All subjects gave written informed consent and the study was approved by the Ethical Committee of our Institution.

Procedures
Standard Doppler echocardiography and pulsed tissue Doppler were performed by Vivid Seven (GE, Horten, Norway) equipped with tissue Doppler capabilities. A 2.5 MHz transducer was used for Doppler-echo and tissue Doppler recording. At the end of the study, cuff blood pressure (mean of 3 measurements) was estimated by a physician blinded to the examination.

Standard echocardiographic examination
M-mode tracings were recorded in parasternal long-axis view and measurements of left ventricle obtained according to standards of our laboratory.22 Left ventricular systolic function was evaluated as endocardial fractional shortening. Relative diastolic wall thickness was determined as the ratio of the sum of septal and posterior wall thickness to left ventricular internal end-diastolic diameter. Left ventricular mass was normalized for height to the power 2.7.23 Transmitral pulsed Doppler was recorded in the apical 4-chamber view: early (E) and atrial (A) peak velocities (m/s), peak velocity E/A ratio and E velocity deceleration time (ms) were measured according to the methods of our laboratory.22

Pulsed tissue Doppler
Pulsed tissue Doppler was performed by transducer frequencies of 3.5–4.0 MHz, adjusting the spectral pulsed Doppler signal filters until they reached a Nyquist limit of 15–20 cm/s, and using the minimum optimal gain. In apical 4-chamber view, a 5 mm pulsed Doppler sample volume was sequentially placed at the level of the lateral mitral annulus and septal mitral annulus. Sm velocity was measured as a myocardial systolic index. Em, Am velocities and Em/Am ratio were determined as myocardial diastolic measurements. All tissue Doppler parameters were obtained also as the average of the values of the lateral and septal mitral annulus. The ratio of Doppler transmitral E peak velocity and average Em peak velocity (lateral Em + septal Em/2) was calculated as an index of left ventricular filling pressure.10 Tissue Doppler methods and reproducibility in our laboratory have been described previously.24

Statistical analysis
Data are presented as mean value ± SD. Descriptive statistics were obtained by one-factor ANOVA and {chi}2 distribution with computation of exact P value by Monte Carlo method. Least squares linear regression was used to evaluate univariate and multivariate correlates of tissue Doppler measurements. For multiple linear regression models, multicollinearity was also examined by computation of in-model tolerance. Collinearity was considered acceptable and regression model stable for tolerance >0.70. The null hypothesis was rejected for P < 0.05.


   Results
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 Introduction
 Methods
 Results
Univariate relations of tissue...
 Discussion
 References
 
The study population was divided into seven decades of age: 10–19 years, 20–29 years, 30–39 years, 40–49 years, 50–59 years, 60–69 years, >70 years. Table 1 reports both the clinical characteristics and the main Doppler echocardiographic measurements of the study population according to age decades. As expected, body mass index, blood pressure, relative diastolic wall thickness and left ventricular mass index increased significantly with age. No difference of heart rate and endocardial fractional shortening was found among the various age groups. Transmitral E peak velocity was progressively reduced, A peak velocity was increased and both deceleration time and isovolumic relaxation time prolonged with advancing age. Of note, no subjects had any wall motion abnormality or any significant valvular heart disease (data not shown in table).


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  		Table 1 Clinical and Doppler echocardiographic characteristics of the population according to age decades

 
Table 2 lists the results of tissue Doppler parameters of lateral and of septal mitral annulus as well as of E/Em ratio and their averages according the age decades. Similar to homologous standard Doppler measurements, Em was progressively reduced and Am increased with increasing age at both the annular sides as well as the average values. Also Sm showed a trend to progressively reduce with advancing age but this reduction was significant only at the lateral mitral annulus or as average values. Average E/Em ratio was particularly higher in the last three decades of age (50–59, 60–69 and >70 years), (P < 0.0001) (Figure 1). Average E/Em ratio was >10 in 16 of the total 246 healthy subjects (6.5%) but none had a ratio >15. In particular, 5/45 subjects (11.1%) in the decade 50–59, 5/25 (20.0%) in the decade 60–69 and 4/20 (20%) >70 years showed a E/Em ratio >10. Of interest, in the pooled population E/Em ratio >10 was able to unmask a pseudonormal transmitral filling pattern only in 4 of the 246 subjects (1.6%), while the majority of the subjects with E/Em ratio >10 (4.9%) presented a transmitral pattern of left ventricular abnormal relaxation. Figures 2 and 3 depict an E/Em ratio in a young (17-year old) subject and in a 57-year old subject, respectively.


Figure 1
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  		Figure 1 Increase of average E/Em ratio with advancing age in six age decades.

 


Figure 2
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  		Figure 2 E/Em ratio in normal 17-year-old subject is 5.7. The values of Em peak velocities are substantially different between septal (lower values) and lateral side (higher values) of the mitral annulus. Upper panel: Doppler transmitral inflow pattern. Lower panel: pulsed tissue Doppler of septal (left) and lateral (right) mitral annulus.

 


Figure 3
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  		Figure 3 E/Em ratio in a normal 58-year-old subject is 7.2. The values of Em peak velocities are again different between septal and lateral side of the mitral annulus. Upper panel: Doppler transmitral inflow pattern. Lower panel: pulsed tissue Doppler of septal (left) and lateral (right) mitral annulus.

 


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  		Table 2 Pulsed tissue Doppler measurements of mitral annulus according to age decades

 

   Univariate relations of tissue Doppler measurements
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 Introduction
 Methods
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 Univariate relations of tissue...
Discussion
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Age showed strong correlation with lateral Am (r = 0.50), septal Am (r = 0.57) and average Am (r = 0.60) (all P < 0.0001), with lateral Em, septal Em and average Em (all P < 0.0001) (Figure 4), with E/Em ratio (all P < 0.0001) (Figure 5) and with both lateral Sm (r = –0.38; P < 0.0001), septal Sm (r = –0.14, P < 0.05) and average Sm (r =– 0.37; P < 0.0001) (Figure 6).


Figure 4
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  		Figure 4 Scatterplot and regression lines of the relation of age with lateral Em (upper left panel), septal Em (upper right panel) and average Em (lower panel).

 


Figure 5
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  		Figure 5 Scatterplot and regression lines of the relation of age with lateral E/Em (upper left panel), septal E/Em (upper right panel) and average E/Em ratio (lower panel).

 


Figure 6
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  		Figure 6 Scatterplot and regression lines of the relation of age with lateral Sm (upper left panel), septal Sm (upper right panel) and average Sm.(lower panel).

 
Among the other clinical variables, body mass index was significantly related to Am (septal: r = 0.36, P < 0.0001; lateral: r = 0.28, P < 0.002; average: r = 0.35, P < 0.0001), with Em (septal: r = –0.29, lateral: r = –0.31, average: r = –0.32, all P < 0.0001) and with average E/Em ratio (r = 0.16, P < 0.01); heart rate was associated with Sm (septal: r = 0.21, P < 0.001; lateral: r = 0.28, P < 0.0001; average: r = 0.30, P < 0.0001), pulse pressure (but not systolic and diastolic BP) was related to Em (septal: r = –0.35, lateral: r = –0.35, average: r = –0.38, all P < 0.0001) and with E/Em ratio (septal: r = 0.28, lateral: r = 0.32, average: r = 0.36, all P < 0.0001). Among the echocardiographic variables, left ventricular mass index was related to Em (septal: r = –0.33, lateral: r = –0.32, average: r = –0.34, all P < 0.0001) and with average E/Em ratio (r = 0.16, P < 0.01), relative diastolic wall thickness with Am (septal: r = 0.18, lateral: r = 0.18, average: r = 0.21, P < 0.001), with Sm (lateral: r = –0.18, P < 0.005; average: r = –0.16, p < 0.01), with Em (septal: r = –0.33, lateral: r = –0.38, average: r = –0.39, P < 0.0001) and with average E/Em ratio (r = 0.27, P < 0.0001). Endocardial fractional shortening was marginally related to Sm (septal: r = 0.13, P < 0.05, lateral: r = 0.13, P < 0.05, average: r = 0.15, P < 0.01).

Multiple linear regression analyses
Multiple linear regression analyses were performed to identify the independent association between the main demographic, clinical and echocardiographic variables and tissue Doppler measurements. By these analyses, age was the main independent predictor of average Em, average Am and average E/Em ratio, while heart rate was the most important contributor to average Sm, with the additional independent contribution of age (Table 3).


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  		Table 3 Multiple independent correlates of tissue Doppler variables in the overall population

 

   Discussion
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 Abstract
 Introduction
 Methods
 Results
 Univariate relations of tissue...
 Discussion
References
 
The present study confirms and extends previously published data on the impact on age of pulsed tissue Doppler diastolic and systolic measurements of left ventricular mitral annulus and of E/Em ratio. Table 4 summarizes the main characteristics and findings of the reports which previously analyzed measurements of either septal or lateral mitral annulus. Only two of these studies sampled both septal and lateral annulus but, to the best of our knowledge, we are the first to provide information about the average annular values of both myocardial systolic and diastolic velocities. Similar data were described by using off-line measurements of color tissue Doppler which records mean and not instantaneous myocardial velocities.25,26 It has also to be taken into account that our normal population was highly selected since not only subjects with any kind of cardiovascular disease (including arterial hypertension and coronary artery disease) but also subjects with mild overweight were excluded by the analysis.


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  		Table 4 Main findings of the reports dealing with normative values of pulsed tissue Doppler in healthy subjects

 
By using pulsed tissue Doppler some researchers prefer the sampling of the septal side of the mitral annulus because this moves parallel to the ultrasound beam and is less influenced by the translation movement of the heart.6 Others, however, encourage the sampling at the junction between left ventricular lateral wall and mitral annulus2 since septal velocities may be conditioned by the right ventricular interaction. The rationale of averaging septal and lateral values arises from the observation that a definite discrepancy in detecting left ventricular myocardial diastolic dysfunction emerges by using septal (overestimation) or lateral (underestimation) values.9 In addition, Em velocities are significantly greater at the lateral location than at the septal placement of the mitral annulus in healthy subjects.27 On these grounds we averaged pulsed Tissue Doppler values of diastolic and systolic velocities measured at the septal and the lateral side of the mitral annulus, and E/Em ratio was obtained by using average Em.

The findings of the present study demonstrate that aging produces a progressive impairment of myocardial systolic function (Sm velocity) and of myocardial relaxation (Em velocity), and increase of both myocardial atrial activity (Am velocity) and of left ventricular filling pressure (i.e., of E/Em ratio). The maximal increase of E/Em ratio was observed in the last three age decades, since 11.1% in the decade 50–59 years and 20% in both groups 60–69 and >70 years presented values >10. An E/Em ratio >10 usually predicts a mean capillary wedge pressure >15 mmHg with 97% sensitivity and 78% specificity.5 However, in asymptomatic subjects with normal left ventricular systolic function, as in the healthy subjects of the present study, a cut-off point >15 should be considered more appropriate to identify abnormally increased left ventricular filling pressure10 and none of our population overcame this value. Similar data had been obtained by other authors who used septal20,21 or lateral values17 of the mitral annulus but not the average values of the two annular sides. It is also of interest that an average E/Em ratio >10 was able to unmask a left ventricular pseudonormal filling pattern only in a small amount (1.6%) of our pooled population while the majority of the subjects with increased E/Em ratio showed a pattern of abnormal relaxation, with a strongly reduced Em velocity, attributable to aging-related impairment of myocardial relaxation.

Our multiple linear regression analyses provided additional information. Age emerged as the strongest contributor of average Em reduction and of average Am and E/Em ratio increase. The association of age with these measurements was independent on the influence exerted by clinical and echocardiographic confounders including pulse pressure, a recognized index of arterial stiffness,28 and relative wall thickness, a reliable marker of left ventricular geometric changes.29 Of note, both pulse pressure and relative wall thickness are strongly influenced by aging.30,31 These findings suggest that the physiologic, aging-related impairment of left ventricular longitudinal diastolic function occurs irrespective of changes in arterial stiffness and left ventricular geometry.

While these data have a clinical value, some physiopathologic mechanisms underlying the impact of aging on left ventricular longitudinal diastolic function have to be underlined. The progressive reduction of myocardial relaxation with aging was firstly described by experimental studies32 and subsequently confirmed by invasive33 and noninvasive reports34,35 in humans. With increasing age, the prolongation of isovolumic relaxation time and the loss of left ventricular compliance contribute to reduce the efficacy of myocardial early diastolic activity. This is due to ultrastructural modification of cardiomyocytes involving calcium cellular transport by the sarcoplasmic reticulum.32 Worthy of note, tissue Doppler derived Em velocity is a reliable index of myocardial relaxation since a significant relation with invasively determined t has been clearly demonstrated.5–8

Also the impairment of left ventricular myocardial systolic performance with aging had been previously documented, in animals36 as in humans.37 By using pulsed tissue Doppler, Yu et al.19 showed an age-dependent decline of Sm measured at septal, lateral, inferior, anterior and posterior sides of the mitral annulus. Our experience extends this information since this reduction involved the average Sm values of the mitral annulus, while the age-dependent decline of Sm did not achieve the statistical significance at the septal side. In the multivariate model, although heart rate was the strongest independent predictor of average Sm velocity, the association of age and Sm remained significant. Age-related changes of force–frequency relationship were previously demonstrated in isolated papillary muscles of guinea pigs.38 In the present study, the gradual reduction of Sm with aging was not accompanied by a decrease of endocardial shortening, a discrepancy already reported by other authors.39 The effect of aging on left ventricular longitudinal myocardial function, detectable by pulsed tissue Doppler, may precede the age-related detrimental effect on LV chamber systolic function. The age-dependent worsening of longitudinal systolic function, observed in healthy subjects also by cardiac magnetic resonance, has been ascribed to the smaller left ventricular volumes and higher wall thickness occurring with aging.40 Of note, the age-related reduction of Sm in our healthy subjects parallels the increase of relative wall thickness, which indicates the development of concentric geometry of the left ventricle in elderly people.

In conclusion, our findings demonstrate an independent impact of aging on average myocardial systolic and diastolic indexes obtained by pulsed tissue Doppler of septal and lateral mitral annulus in a highly selected population of normal subjects. The present study also provides normal values of tissue Doppler average variables for age decades, which can be used as reference data for the quantitative assessment of longitudinal left ventricular function in patients with cardiac disease. Similar to standard Doppler mitral inflow, when analyzing left ventricular longitudinal myocardial function in patients with cardiovascular disorders, the physiological influence of aging on pulsed tissue Doppler should be carefully taken into account.


   References
Top
 Abstract
 Introduction
 Methods
 Results
 Univariate relations of tissue...
 Discussion
 References
 

  1. Isaaz K, Thompson A, Ethevenot G, Cloez JL, Brembilla B, Pernot C. Doppler echocardiographic measurement of low velocity motion of the left ventricular posterior wall. Am J Cardiol (1989) 64:66–75.[CrossRef][Web of Science][Medline]
  2. Garcia MJ, Rodriguez L, Ares M, Griffin BP, Thomas JD, Klein AL. Differentiation of constrictive pericarditis from restrictive cardiomyopathy: assessment of left ventricular diastolic velocities in longitudinal axis by Doppler tissue imaging. J Am Coll Cardiol (1996) 27:108–14.[Abstract]
  3. Quinones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standard Committee of the American Society of Echocardiography. J Am Soc Echocardiogr (2002) 15:167–84.[CrossRef][Web of Science][Medline]
  4. Galderisi M, Dini FL, Temporelli PL, Colonna P, de Simone G. Doppler echocardiography for the assessment of left ventricular diastolic function: methodology, clinical and prognostic value. Ital Heart J Suppl (2004) 5:86–7.[Medline]
  5. Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones MA. Doppler tissue imaging: a non-invasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol (1997) 30:1527–33.[Abstract]
  6. Sohn DW, Chai IH, Lee DJ, Kim HC, Kim HS, Oh BH, et al. Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol (1997) 30:474–80.[Abstract]
  7. Rodriguez L, Garcia M, Ares M, Griffin BP, Nakatani S, Thomas JD. Assessment of mitral annular dynamics during diastole by Doppler tissue imaging: comparison with mitral Doppler inflow in subjects without heart disease and in patients with left ventricular hypertrophy. Am Heart J (1996) 131:982–7.[CrossRef][Web of Science][Medline]
  8. Nagueh SF, Sun H, Kopelen HA, Middleton KJ, Khoury DS. Hemodynamic determinants of the mitral annulus diastolic velocities by Tissue Doppler. J Am Coll Cardiol (2001) 37:278–85.[Abstract/Free Full Text]
  9. Park HS, Naik SD, Aronow SW, Visintainer PF, Das M, McClung JA, et al. Differences of lateral and septal mitral annulus velocity by Tissue Doppler imaging in the evaluation of left ventricular diastolic function. Am J Cardiol (2006) 98:970–2.[CrossRef][Web of Science][Medline]
  10. Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, et al. Clinical utility of Doppler echocardiography and Tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circulation (2000) 102:1788–94.[Abstract/Free Full Text]
  11. Bruch C, Grude M, Muller J, Breithardt G, Wichter T. Usefulness of Tissue Doppler imaging for estimation of left ventricular filling pressures in patients with systolic and diastolic heart failure. Am J Cardiol (2005) 95:892–5.[CrossRef][Web of Science][Medline]
  12. Gulati VK, Katz WE, Follansbee WP, Gorcsan J 3rd. Mitral annular descent velocity by Tissue Doppler echocardiography as an index of global left ventricular function. Am J Cardiol (1996) 77:979–84.[CrossRef][Web of Science][Medline]
  13. Alam M, Wardell J, Andersson E, Nordlander R, Samad B. Assessment of left ventricular function using mitral annular velocities in patients with congestive heart failure with or without the presence of significant mitral regurgitation. J Am Soc Echocardiogr (2003) 16:240–5.[CrossRef][Web of Science][Medline]
  14. Mishiro Y, Oki T, Yamada H, Wakatsuki T, Ito S. Evaluation of left ventricular contraction abnormalities in patients with dilated cardiomyopathy with the use of pulsed Tissue Doppler imaging. J Am Soc Echocardiogr (1999) 12:913–20.[CrossRef][Web of Science][Medline]
  15. Hillis GS, Moller JE, Pellikka PA, Wright RS, Ommen SR, et al. Noninvasive estimation of left ventricular filling pressure by E/e' is a powerful predictor of survival after acute myocardial infarction. J Am Coll Cardiol (2004) 43:360–7.[Abstract/Free Full Text]
  16. Nikitin NP, Loh PH, de Silva R, Ghosh J, Khaleva OY, Goode K, et al. Prognostic value of systolic mitral annular velocity measured with Doppler tissue imaging in patients with chronic heart failure caused by left ventricular systolic dysfunction. Heart (2006) 92:775–9.[Abstract/Free Full Text]
  17. Tighe DA, Vinch CS, Hill JC, Meyer TE, Goldberg RJ, Aurigemma GP. Influence of age on assessment of diastolic function by Doppler tissue imaging. Am J Cardiol (2003) 91:254–7.[CrossRef][Web of Science][Medline]
  18. Munagala VK, Jacobsen SJ, Mahoney DW, Rodeheffer RJ, Bailey KR, Redfield MM. Association of newer diastolic function parameters with age in healthy subjects: a population based study. J Am Soc Echocardiogr (2003) 16:1049–56.[CrossRef][Web of Science][Medline]
  19. Yu WC, Lee WS, Huang WP, Wu CC, Lin YP, Chen CH. Evaluation of cardiac function by tissue Doppler echocardiography: hemodynamic determinants and clinical application. Ultrasound Med Biol (2005) 31:23–30.[CrossRef][Web of Science][Medline]
  20. De Sutter J, De Backer J, Van de Veire N, Velghe A, De Buyzere M, Gillebert TC. Effects of age, gender, and left ventricular mass on septal mitral annulus velocity (E') and the ratio of transmitral early peak velocity to E'(E/E'). Am J Cardiol (2005) 95:1020–3.[CrossRef][Web of Science][Medline]
  21. Van de Veire NR, De Backer J, Ascoop AK, Middernacht B, Velghe A, De Sutter JD. Echocardiographically estimated left ventricular end-diastolic and right ventricular systolic pressure in normotensive healthy individuals. Int J Cardiovasc Imaging (2006) 22:633–41.[CrossRef][Web of Science][Medline]
  22. Galderisi M, Paolisso G, Tagliamonte MR, Alfieri A, Petrocelli A, de Divitiis M, et al. Is insulin action a determinant of left ventricular relaxation in uncomplicated essential hypertension? J Hypertens (1997) 15:745–50.[CrossRef][Web of Science][Medline]
  23. de Simone G, Daniels SR, Devereux RB, Meyer RA, Roman MJ, de Divitiis O, et al. Left ventricular mass and body size in normotensive children and adults: assessment of allometric relations and impact of overweight. J Am Coll Cardiol (1992) 20:1251–60.[Abstract]
  24. Galderisi M, Caso P, Severino S, Petrocelli A, de Divitiis O, Mininni N. Myocardial diastolic impairment due to left ventricular hypertrophy involves basal septum more than other walls: analysis by pulsed Doppler Tissue Imaging. J Hypertension (1999) 17:685–93.[CrossRef][Web of Science][Medline]
  25. Nikitin NP, Witte KKA, Thackray SDR, de Silva R, Clark AL. Cleland JGF Longitudinal ventricular function: normal values of atrioventricular annular and myocardial velocities measured with quantitative two-dimensional color Doppler tissue imaging. J Am Soc Echocardiogr (2003) 16:906–21.[CrossRef][Web of Science][Medline]
  26. Lind B, Eriksson M, Roumina S, Nowark J, Brodin LA. Longitudinal isovolumic displacement of the left ventricular myocardium assessed by tissue velocity Echocardiography in healthy individuals. J Am Soc Echocardiogr (2006) 19:255–65.[CrossRef][Web of Science][Medline]
  27. Alam M, Wardell J, Andersson E, Samad BA, Nordlander R. Characteristics of mitral and tricuspid annular velocities determined by pulsed wave Doppler tissue imaging in healthy subjects. J Am Soc Echocardiogr (1999) 12:618–28.[CrossRef][Web of Science][Medline]
  28. Safar ME. Pulse pressure in essential hypertension: clinical and therapeutical implications. J Hypertens (1989) 7:769–76.[CrossRef][Web of Science][Medline]
  29. Ganau A, Devereux RB, Roman MJ, de Simone G, Pickering TG, Saba PS, Laragh JH, et al. Patterns of left ventricular hypertrophy and geometric remodeling in essential hypertension. J Am Coll Cardiol (1992) 19:1550–8.[Abstract]
  30. Franklin SS. Cardiovascular risk related to increased diastolic, systolic and pulse pressure. An epidemiologic point of view. Pathol Biol (Paris) (1999) 47:594–603.[Medline]
  31. de Simone G, Daniels SR, Kimball TR, Roman MJ, Romano C, Chinali M, et al. Evaluation of concentric left ventricular geometry in humans: evidence for age-related systematic underestimation. Hypertension (2005) 45:64–8.[Abstract/Free Full Text]
  32. Kaufman TM, Horton JW, White DJ, Mahony L. Age-related changes in myocardial relaxation and sarcoplasmic reticulum function. Am J Physiol (1990) 259:H309–16.[Web of Science][Medline]
  33. Hirota Y. A clinical study of left ventricular relaxation. Circulation (1980) 62:756–63.[Abstract/Free Full Text]
  34. Spirito P, Maron BJ, Bonow RO. Noninvasive assessment of left ventricular diastolic function: comparative analysis of Doppler echocardiographic and radionuclide angiographic techniques. J Am Coll Cardiol (1986) 7:518–26.[Abstract]
  35. Sagie A, Benjamin EJ, Galderisi M, Larson MG, Evans JC, Fuller DL, et al. Reference values for Doppler indexes of left ventricular diastolic filling in the elderly. J Am Soc Echocardiogr (1993) 6:570–6.[Medline]
  36. Urthaler F, Walker AA, James TN. The effect of aging on ventricular contractile performance. Am Heart J (1978) 96:481–5.[CrossRef][Web of Science][Medline]
  37. Port S, Cobb FR, Coleman RE, Jones RH. Effect of age on the response of the left ventricular ejection fraction to exercise. N Engl J Med (1980) 303:1133–7.[Abstract]
  38. Rumberger E, Timmermann J. Age-changes of the force-frequency- relationship and the duration of action potential of isolated papillary muscles of guinea pig. Eur J Appl Physiol Occup Physiol (1976) 35:277–84.[CrossRef][Web of Science][Medline]
  39. Palmieri V, Russo C, Arezzi E, Pezzullo S, Sabatella M, Minichiello S, et al. Relations of longitudinal left ventricular systolic function to left ventricular mass, load, and Doppler stroke volume. Eur J Echocardiogr (2006) 7:348–55.[Abstract/Free Full Text]
  40. Nikitin NP, Loh PH, de Silva R, Witte KK, Lukaschuk EJ, Parker A, et al. Left ventricular morphology, global and longitudinal function in normal older individuals: a cardiac magnetic resonance study. Int J Cardiol (2006) 108:76–83.[CrossRef][Web of Science][Medline]

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