Yoshiaki Maruyama

Aging and arterial-cardiac interactions in the elderly.

Cardiovascular system changes with aging, and these changes are modified by arteriosclerosis-risk factors, i.e., hypertension and diabetes, as well as arterial-cardiac interactions. Regarding age-related changes in the cardiovascular system, Lakatta et al. reported morphological and functional changes that are specific to the cardiovascular aging and are distinct from arteriosclerotic changes. After then, various studies on the mechanism of aging of the cardiovascular system have been performed from the viewpoint of cellular aging, endothelial or endocardial function, and fibroblast. Aging-related changes in the cardiovascular system include death and dysfunction of cell, and matrix fibrosis, but these can also be induced by various causes other than aging. To elucidate the relationship between aging and remodeling of the cardiovascular system, firstly, it is necessary to clarify the phenomena of cellular aging. Changes also differ between the heart and arteries, and there are time lags between aging and aging-associated morphological and functional changes in the cardiovascular system: some changes appear early (early type) or later (delayed type) and some changes occur at the same speed with aging (linear type). In this report, the latest findings concerning aging-associated functional and morphological changes in the arteries and the heart are reviewed and the studies are summarized. Arteries and the heart change with aging while interacting with each other. These arterial-cardiac interactions are also described.

Aging-related arterial-cardiac interaction in Japanese men

Vascular and cardiac aging is rapidly progressing among the Japanese population. A close relation exists between the artery and cardiac performance (arterial-cardiac interaction), but the relationships between age and these parameters have not been well examined. The aim of this study was to elucidate the changes of arterial-cardiac interaction with aging, using pulse wave velocity (PWV) as an indicator of atherosclerosis. The subjects comprised 595 adult men (mean age, 58.8 ± 12.2 years) without any history of cardiovascular disease. After correlating PWV, cardiac structure, cardiac function, and blood pressure to age, subjects were divided into five age groups to compare changes in these parameters. Pulse wave velocity exhibited a strong positive correlation with age (r = 0.461, P < 0.01) and increased significantly over 55 years old, and left atrial dimension, relative wall thickness, systolic blood pressure, and pulse pressure correlated positively with age and increased similarly. Left ventricular volume correlated negatively with age and decreased similarly. These parameters significantly correlated with PWV. Aortic diameter (AoD) positively and EA ratio (E/A) negatively exhibited a correlation with age and revealed earlier change before PWV increase. Aortic diameter increased significantly over 45 years old and stayed flat, but E/A decreased linearly from the early period. Diastolic blood pressure (DBP) increased in the early period and decreased over 75 years of age. Agerelated atherosclerotic close arterial-cardiac interaction exists between the vessels and cardiac performance, but AoD, E/A, and DBP change in early age independent of atherosclerosis.

Dyssynchrony during acute phase determined by real-time three-dimensional echocardiography predicts reverse cardiac remodeling and improved cardiac function after reperfusion therapy

OBJECTIVES The aim of this study was to investigate whether parameters of dyssynchrony from real-time three-dimensional echocardiography (RT-3DE) can predict cardiac remodeling in patients of acute myocardial infarction (AMI) after reperfusion therapy. METHODS The subjects were 41 AMI patients after reperfusion therapy who underwent RT-3DE within 2 weeks from onset and at 6 months thereafter. End-diastolic volume (EDV), end-systolic volume (ESV), ejection fraction (EF), and the change rate of these parameters were derived during the acute and chronic phases. Two parameters of dyssynchrony, the systolic timing dispersion index (SDII) and systolic timing deviation index (SDEI) were calculated from RT-3DE. Intra- and inter-observer variability of dyssynchrony parameters and correlation of acute cardiac and dyssynchrony parameters with chronic remodeling were compared using linear and multiple regression analysis. RESULTS Parameters of dyssynchrony from RT-3DE revealed small intra- and inter-observer variability. Acute EDV, acute ESV, and acute EF correlated with chronic remodeling but not with the change rate of these parameters. SDII correlated negatively with chronic remodeling and positively with chronic EF, and the change rate of these parameters. Multiple regression analysis revealed SDII was an independent predictor for cardiac remodeling. CONCLUSIONS Dyssynchrony parameters derived from RT-3DE are useful for predicting reverse cardiac remodeling and further improvement in cardiac function.