In patients free of cardiovascular disease at baseline, we observed a longitudinal left ventricular (LV) mass increase in men and a slight decrease in women, whereas LV end-diastolic volume decreased and mass-to-volume ratio increased in both men and women.
To evaluate age-related left ventricular (LV) remodeling during longitudinal observation of a large cohort of asymptomatic individuals who were free of clinical cardiovascular disease at baseline.
Materials and Methods
The applicable institutional review boards approved this study, and all participants gave informed consent. Cardiac magnetic resonance (MR) imaging was used to identify longitudinal changes in LV structure and function in 2935 participants who underwent baseline and follow-up cardiac MR imaging in the Multi-Ethnic Study of Atherosclerosis. Participants were free of clinical cardiovascular disease at baseline. Participants who experienced an incident coronary heart disease event were excluded. Data were analyzed with multivariable mixed-effects regression models in which the outcome was cardiac MR imaging measurement, and the covariates included follow-up time and cardiac risk factors.
Participants were aged 54–94 years at follow-up, and 53% of the participants were women. Median time between baseline and follow-up cardiac MR imaging was 9.4 years. Over this period, LV mass increased in men and decreased slightly in women (8.0 and −1.6 g per decade, respectively; P < .001). In both men and women, LV end-diastolic volume decreased (−9.8 and −13.3 mL per decade, respectively; P < .001), stroke volume decreased (−8.8 and −8.6 mL per decade, respectively; P < .001), and mass-to-volume ratio increased (0.14 and 0.11 g/mL per decade, respectively; P < .001). Change in LV mass was positively associated with systolic blood pressure and body mass index and negatively associated with treated hypertension and high-density lipoprotein cholesterol level. In men, the longitudinal LV mass increase was in contrast to a cross-sectional pattern of LV mass decrease.
As patients age, the LV responds differently in its mass and volume between men and women, although both men and women experience increased concentric LV remodeling with age. In men, the opposition of longitudinal and cross-sectional changes in LV mass highlights the importance of longitudinal study.
© RSNA, 2015
- 1. . Left ventricular mass and incidence of coronary heart disease in an elderly cohort. The Framingham Heart Study. Ann Intern Med 1989;110(2):101–107. Crossref, Medline, Google Scholar
- 2. . Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med 1990;322(22):1561–1566. Crossref, Medline, Google Scholar
- 3. . M-mode echocardiographic predictors of six- to seven-year incidence of coronary heart disease, stroke, congestive heart failure, and mortality in an elderly cohort (the Cardiovascular Health Study). Am J Cardiol 2001;87(9):1051–1057. Crossref, Medline, Google Scholar
- 4. . The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic Study of Atherosclerosis) study. J Am Coll Cardiol 2008;52(25):2148–2155. Crossref, Medline, Google Scholar
- 5. . Congestive heart failure, coronary events and atherothrombotic brain infarction in elderly blacks and whites with systemic hypertension and with and without echocardiographic and electrocardiographic evidence of left ventricular hypertrophy. Am J Cardiol 1991;67(4):295–299. Crossref, Medline, Google Scholar
- 6. . Left ventricular mass predicts heart failure not related to previous myocardial infarction: the Cardiovascular Health Study. Eur Heart J 2008;29(6):741–747. Crossref, Medline, Google Scholar
- 7. . Prognostic significance of left ventricular mass change during treatment of hypertension. JAMA 2004;292(19):2350–2356. Crossref, Medline, Google Scholar
- 8. . Cardiac remodeling at the population level: risk factors, screening, and outcomes. Nat Rev Cardiol 2011;8(12):673–685. Crossref, Medline, Google Scholar
- 9. . Association of echocardiographic left ventricular mass with body size, blood pressure and physical activity (the Framingham Study). Am J Cardiol 1990;65(5):371–376. Crossref, Medline, Google Scholar
- 10. . Predictors of left ventricular mass in old age: an echocardiographic, clinical and biochemical investigation of a random population sample. Eur Heart J 1994;15(6):769–780. Crossref, Medline, Google Scholar
- 11. . Sex, age, and disease affect echocardiographic left ventricular mass and systolic function in the free-living elderly. The Cardiovascular Health Study. Circulation 1995;91(6):1739–1748. Crossref, Medline, Google Scholar
- 12. . Relationship of cardiovascular risk factors to echocardiographic left ventricular mass in healthy young black and white adult men and women. The CARDIA study. Coronary Artery Risk Development in Young Adults. Circulation 1995;92(3):380–387. Crossref, Medline, Google Scholar
- 13. . Age-related left ventricular remodeling and associated risk for cardiovascular outcomes: the Multi-Ethnic Study of Atherosclerosis. Circ Cardiovasc Imaging 2009;2(3):191–198. Crossref, Medline, Google Scholar
- 14. . Longitudinal tracking of left ventricular mass over the adult life course: clinical correlates of short- and long-term change in the Framingham Offspring Study. Circulation 2009;119(24):3085–3092. Crossref, Medline, Google Scholar
- 15. . Multi-ethnic study of atherosclerosis: objectives and design. Am J Epidemiol 2002;156(9):871–881. Crossref, Medline, Google Scholar
- 16. . Cardiovascular function in multi-ethnic study of atherosclerosis: normal values by age, sex, and ethnicity. AJR Am J Roentgenol 2006;1863(6 Suppl 2):S357–S365. Crossref, Google Scholar
- 17. . Traditional cardiovascular risk factors in relation to left ventricular mass, volume, and systolic function by cardiac magnetic resonance imaging: the Multiethnic Study of Atherosclerosis. J Am Coll Cardiol 2006;48(11):2285–2292. Crossref, Medline, Google Scholar
- 18. . Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972;18(6):499–502. Crossref, Medline, Google Scholar
- 19. . Multisite image data collection and management using the RSNA image sharing network. Transl Oncol 2014;7(1):36–39. Crossref, Medline, Google Scholar
- 20. . Left ventricular mass and volume: fast calculation with guide-point modeling on MR images. Radiology 2000;216(2):597–602. Link, Google Scholar
- 21. . Anthropometric measurement error and the assessment of nutritional status. Br J Nutr 1999;82(3):165–177. Crossref, Medline, Google Scholar
- 22. . Cine MR angiography of the heart with segmented true fast imaging with steady-state precession. Radiology 2001;219(3):828–834. Link, Google Scholar
- 23. . Cardiac cine MRI: quantification of the relationship between fast gradient echo and steady-state free precession for determination of myocardial mass and volumes. J Magn Reson Imaging 2008;28(1):60–66. Crossref, Medline, Google Scholar
- 24. . Age-period-cohort analysis. In: Armitage P, Colton T, eds. Encyclopedia of biostatistics. New York, NY: Wiley, 1998; 82–99. Google Scholar
- 25. . Comprehensive analysis of left ventricular geometry and function by three-dimensional echocardiography in healthy adults. J Am Soc Echocardiogr 2013;26(6):618–628. Crossref, Medline, Google Scholar
- 26. . Population-based reference values for 3D echocardiographic LV volumes and ejection fraction. JACC Cardiovasc Imaging 2012;5(12):1191–1197. Crossref, Medline, Google Scholar
- 27. . Normal values of real-time 3-dimensional echocardiographic parameters in a healthy Japanese population: the JAMP-3D Study. Circ J 2012;76(5):1177–1181. Crossref, Medline, Google Scholar
- 28. . Exercise cardiac output is maintained with advancing age in healthy human subjects: cardiac dilatation and increased stroke volume compensate for a diminished heart rate. Circulation 1984;69(2):203–213. Crossref, Medline, Google Scholar
- 29. . Hemodynamic effects of unloading the old heart. Am J Physiol 1999;277(5 Pt 2):H1863–H1871. Medline, Google Scholar
- 30. . Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance; are they interchangeable? Eur Heart J 2000;21(16):1387–1396. Crossref, Medline, Google Scholar
- 31. . General mechanisms of nicotine-induced fibrogenesis. FASEB J 2012;26(12):4778–4787. Crossref, Medline, Google Scholar
- 32. . Cigarette smoking induces atrial fibrosis in humans via nicotine. Heart 2007;93(9):1056–1063. Crossref, Medline, Google Scholar
- 33. . Hypertension and smoking are associated with reduced regional left ventricular function in asymptomatic individuals the Multi-Ethnic Study of Atherosclerosis. J Am Coll Cardiol 2006;47(6):1150–1158. Crossref, Medline, Google Scholar
- 34. . Left ventricular hypertrophy: pathogenesis, detection, and prognosis. Circulation 2000;102(4):470–479. Crossref, Medline, Google Scholar
- 35. . Evaluation of age-related interstitial myocardial fibrosis with cardiac magnetic resonance contrast-enhanced T1 mapping: MESA (Multi-Ethnic Study of Atherosclerosis). J Am Coll Cardiol 2013;62(14):1280–1287. Crossref, Medline, Google Scholar
- 36. . Toward best practices in analyzing datasets with missing data: comparisons and recommendations. J Marriage Fam 2011;73(5):926–945. Crossref, Google Scholar
Article HistoryReceived April 28, 2015; revision requested June 3; revision received July 7; accepted July 30; final version accepted August 10.
Published online: Oct 20 2015
Published in print: Mar 2016