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May 3, 1995, Vol 273, No. 17 >
ARTICLE | May 3, 1995

Left Ventricular Diastolic Filling Performance in Older Male Athletes FREE

Jerome L. Fleg, MD; Edward P. Shapiro, MD; Frances O'Connor, MPH; Jean Taube; Andrew P. Goldberg, MD; Edward G. Lakatta, MD
[+] Author Affiliations

Reprint requests to Laboratory of Cardiovascular Science, Gerontology Research Center, 4940 Eastern Ave, Baltimore, MD 21224 (Dr Fleg).


JAMA. 1995;273(17):1371-1375. doi:10.1001/jama.1995.03520410065028
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Article
References

Objective.  —To determine whether older men who have undergone intensive endurance training over many years demonstrate less age-associated impairment of early diastolic left ventricular (LV) filling performance than their sedentary peers.

Design.  —Cross-sectional prospective study.

Setting.  —Community-dwelling research volunteers.

Participants.  —Sixteen older competitive male endurance athletes aged 52 through 76 years and 17 young (<40 years) and 23 older (52 through 76 years) sedentary control subjects from the Baltimore Longitudinal Study of Aging.

Intervention.  —All subjects underwent resting Doppler echocardiography and determination of maximal aerobic capacity (V̇o2max) during graded treadmill exercise. Doppler echocardiographic studies were interpreted without knowledge of the subject's age or exercise habits.

Main Outcome Measures.  —Doppler-derived measures of LV diastolic filling performance: peak early (E) filling velocity, peak late (A) filling velocity, ratio of peak E to peak A velocities (E/A), and atrial filling fraction.

Results.  —Older athletes demonstrated higher V̇o2max (47±6 mL/kg per minute [mean±SD]) than either the young controls (41±7 mL/kg per minute) or older controls (30±7 mL/kg per minute) (P<.05) as evidence of their superior conditioning status. However, peak E diastolic LV filling velocity was higher in young controls (79±17 cm/s) than in older athletes (56±15 cm/s) or older controls (68±18 cm/s) (P<.001). This age difference persisted after normalizing peak E velocity for mitral stroke volume. Peak E/A ratio and atrial filling fraction were also similar in older athletes (1.2±0.5 and 0.41±0.1, respectively) and older controls (1.1 ±0.4 and 0.41 ±0.1, respectively), and differed significantly from corresponding values of 1.7±0.4 and 0.33±0.1 in young controls (P<.001 and P<.05, respectively). By multiple regression analysis, age but not treadmill V̇o2max was a significant predictor of peak E velocity, peak A velocity, peak E/A ratio, and atrial filling fraction.

Conclusion.  —Older men with a long history of intensive endurance training demonstrate impaired early diastolic LV filling similar to that of their sedentary peers. Thus, impairment of early diastolic filling appears to be intrinsic to normative aging and not secondary to the reduction in aerobic capacity that accompanies the aging process.(JAMA. 1995;273:1371-1375)

REFERENCES

1 +
Gerstenblith G, Frederiksen J, Yin FCP, Fortuin NJ, Lakatta EG, Weisfeldt ML.  Echocardiography assessment of a normal adult aging population. Circulation . 1977;;56:273-278.
2 +
Gardin JM, Henry WL, Savage DD, Ware JH, Burn C, Borer JS.  Echocardiographic measurements in normal subjects: evaluation of an adult population without clinically apparent heart disease. J Clin Ultrasound . 1979;;7:439-447.
3 +
Miyatake K, Okamoto J, Kinoshita N, et al.  Augmentation of atrial contribution to left ventricular flow with aging as assessed by intracardiac Doppler flowmetry. Am J Cardiol . 1984;;53:587-589.
4 +
Bryg RJ, Williams GA, Labowitz AJ.  Effect of aging on left ventricular diastolic filling in normal subjects. Am J Cardiol . 1987;;59:971-974.
5 +
Sartori MP, Quinones MA, Kuo LC.  Relation of Doppler-derived left ventricular filling parameters to age and radius/thickness ratio in normal and pathologic states. Am J Cardiol . 1987;;59:1179-1182.
6 +
Arora RR, Machac J, Goldman ME, Butler RN, Gorlin R, Horowitz SF.  Atrial kinetics and left ventricular diastolic filling in the healthy elderly. J Am Coll Cardiol . 1987;;9:1255-1260.
7 +
Bonow RO, Vitale DF, Bacharach SL, Maron BJ, Green MV.  Effects of aging on asynchronous left ventricular regional function and global ventricular filling in normal human subjects. J Am Coll Cardiol . 1988;;11:50-58.
8 +
Spurgeon HA, Steinbach MF, Lakatta EG.  Chronic exercise prevents characteristic age-related changes in rat cardiac contraction. Am J Physiol . 1983;;244:H513-H518.
9 +
Starnes JW, Beyer RE, Edington DW.  Myocardial adaptations to endurance exercise in aged rats. Am J Physiol . 1983;;245:H560-H566.
10 +
Tate CA, Taffet GE, Hudson EK, Blaylock SL, McBride RP, Michael LH.  Enhanced calcium uptake of cardiac sarcoplasmic reticulum in exercise-trained old rats. Am J Physiol . 1990;;258:H431-H435.
11 +
Gwathmey JK, Slawsky MT, Perreault CL, Briggs GM, Morgan JP, Wei JY.  The effect of exercise conditioning on excitation-contraction coupling in aged rats. J Appl Physiol . 1990;;69:1366-1371.
12 +
Matsuda M, Sugishita Y, Koseki S, Ito I, Akatsuka T, Takamatso K.  Effect of exercise on left ventricular diastolic filling in athletes and nonathletes. J Appl Physiol . 1983;;55:323-328.
13 +
Finkelhor RS, Hanak LJ, Behler RC.  Left ventricular filling in endurance-trained subjects. J Am Coll Cardiol . 1986;;8:289-293.
14 +
Fortney S, Tankersley C, Lightfoot JT, et al.  Cardiovascular responses to lower body negative pressure in trained and untrained older men. J Appl Physiol . 1992;;73:2693-2700.
15 +
Fleg JL, Lakatta EG.  Role of muscle loss in the age-associated reduction in V̇o2max. J Appl Physiol . 1988;;65:1147-1151.
16 +
Shock NW, Greulich RC, Andres R, et al.  Normal human aging.  In: The Baltimore Longitudinal Study of Aging . Washington, DC: National Institutes of Health; 1984;:45-57. NIH publication 84-2450.
17 +
Rose GA, Blackburn H. Cardiovascular Survey Methods . Geneva, Switzerland: World Health Organization; 1968;.
18 +
Swinne CJ, Shapiro EP, Lima SD, Fleg JL.  Age-associated changes in cardiac performance during isometric exercise in normal subjects. Am J Cardiol . 1992;;69:823-826.
19 +
Sahn DJ, DeMaria A, Kisslo J, Weyman A.  Recommendation regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation . 1978;;58: 1072-1083.
20 +
Bowman LK, Forrester AL, Jaffee CC, et al.  Peak filling rate normalized to mitral stroke volume: a new Doppler echocardiographic filling index validated by radionuclide angiographic techniques. J Am Coll Cardiol . 1988;;12:937-943.
21 +
Devereux RB, Alonso DR, Lutas EM, et al.  Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol . 1986;;57:450-458.
22 +
Kitzman DW, Sheikh KH, Beere PA, Philips JL, Higginbotham MB.  Age-related alterations of Doppler left ventricular filling indexes in normal subjects are independent of left ventricular mass, heart rate, contractility and loading conditions. J Am Coll Cardiol . 1991;;18:1243-1250.
23 +
Douglas PS, O'Toole ML, Hiller DB, Reichek N.  Left ventricular structure and function by echocardiography in ultraendurance athletes. Am J Cardiol . 1986;;58:805-809.
24 +
Colan SD, Sanders SP, MacPherson D, Borow K.  Left ventricular diastolic function in elite athletes with physiologic cardiac hypertrophy. J Am Coll Cardiol . 1985;;6:545-549.
25 +
Fagard R, van den Broeke C, Bielen E, Vanhees L, Amery A.  Assessment of stiffness of the hypertrophied left ventricle of bicyclists using left ventricular inflow Doppler velocimetry. J Am Coll Cardiol . 1987;;9:1250-1254.
26 +
Shapiro LM, Smith RG.  Effect of training on left ventricular structure and function: an echocardiographic study. Br Heart J . 1983;;50:534-539.
27 +
Granger CB, Karimeddini MK, Smith VE, Shapiro HR, Katz AM, Riba AL.  Rapid ventricular filling in left ventricular hypertrophy, I: physiologic hypertrophy. J Am Coll Cardiol . 1985;;5:862-868.
28 +
Forman DE, Manning WJ, Hauser R, Geruino EV, Evans WJ, Wei JW.  Enhanced left ventricular diastolic filling associated with long-term endurance training. J Gerontol . 1992;;47:M56-M58.
29 +
Takemoto KA, Bernstein L, Lopez JF, Marshak D, Rahimtoola SH, Chandraratna PAN.  Abnormalities of diastolic filling of the left ventricle associated with aging are less pronounced in exercise trained individuals. Am Heart J . 1992;;124: 143-148.
30 +
Douglas PS, O'Toole M.  Aging and physical activity determine cardiac structure and function in the older athlete. J Appl Physiol . 1992;;72:1969-1973.
31 +
Appleton CP.  Influence of incremental changes in heart rate or mitral flow velocity: assessment in lightly sedated, conscious dogs. J Am Coll Cardiol . 1991;;17:227-236.
32 +
Harrison MR, Clifton GD, Pennell AT, DeMaria AN.  Effect of heart rate on left ventricular diastolic transmitted flow velocity patterns assessed by Doppler echocardiography in normal subjects. Am J Cardiol . 1991;;87:622-627.
33 +
Levy WC, Cerqueira MD, Abrass IB, et al.  Endurance exercise training augments diastolic filling at rest and during exercise in healthy young and older men. Circulation . 1993;;88:116-126.
34 +
Schulman SP, Lakatta EG, Fleg JL, Lakatta L, Becker LC, Gerstenblith G.  Age-related decline in left ventricular filling at rest and exercise. Am J Physiol . 1992;;263:H1932-H1938.
35 +
Choong CY, Hermann HC, Weyman AE, Fifer MA.  Preload dependence of Doppler-derived indexes of left ventricular diastolic function in humans. J Am Coll Cardiol . 1987;;10:800-808.
36 +
Stoddard MF, Pearson AC, Kern MJ, Ratchiff J, Mrosek DG, Labovitz AJ.  Influences of alteration in preload on the pattern of left ventricular diastolic filling as assessed by Doppler echocardiology in humans. Circulation . 1989;;79:1226-1236.

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1 +
Gerstenblith G, Frederiksen J, Yin FCP, Fortuin NJ, Lakatta EG, Weisfeldt ML.  Echocardiography assessment of a normal adult aging population. Circulation . 1977;;56:273-278.
2 +
Gardin JM, Henry WL, Savage DD, Ware JH, Burn C, Borer JS.  Echocardiographic measurements in normal subjects: evaluation of an adult population without clinically apparent heart disease. J Clin Ultrasound . 1979;;7:439-447.
3 +
Miyatake K, Okamoto J, Kinoshita N, et al.  Augmentation of atrial contribution to left ventricular flow with aging as assessed by intracardiac Doppler flowmetry. Am J Cardiol . 1984;;53:587-589.
4 +
Bryg RJ, Williams GA, Labowitz AJ.  Effect of aging on left ventricular diastolic filling in normal subjects. Am J Cardiol . 1987;;59:971-974.
5 +
Sartori MP, Quinones MA, Kuo LC.  Relation of Doppler-derived left ventricular filling parameters to age and radius/thickness ratio in normal and pathologic states. Am J Cardiol . 1987;;59:1179-1182.
6 +
Arora RR, Machac J, Goldman ME, Butler RN, Gorlin R, Horowitz SF.  Atrial kinetics and left ventricular diastolic filling in the healthy elderly. J Am Coll Cardiol . 1987;;9:1255-1260.
7 +
Bonow RO, Vitale DF, Bacharach SL, Maron BJ, Green MV.  Effects of aging on asynchronous left ventricular regional function and global ventricular filling in normal human subjects. J Am Coll Cardiol . 1988;;11:50-58.
8 +
Spurgeon HA, Steinbach MF, Lakatta EG.  Chronic exercise prevents characteristic age-related changes in rat cardiac contraction. Am J Physiol . 1983;;244:H513-H518.
9 +
Starnes JW, Beyer RE, Edington DW.  Myocardial adaptations to endurance exercise in aged rats. Am J Physiol . 1983;;245:H560-H566.
10 +
Tate CA, Taffet GE, Hudson EK, Blaylock SL, McBride RP, Michael LH.  Enhanced calcium uptake of cardiac sarcoplasmic reticulum in exercise-trained old rats. Am J Physiol . 1990;;258:H431-H435.
11 +
Gwathmey JK, Slawsky MT, Perreault CL, Briggs GM, Morgan JP, Wei JY.  The effect of exercise conditioning on excitation-contraction coupling in aged rats. J Appl Physiol . 1990;;69:1366-1371.
12 +
Matsuda M, Sugishita Y, Koseki S, Ito I, Akatsuka T, Takamatso K.  Effect of exercise on left ventricular diastolic filling in athletes and nonathletes. J Appl Physiol . 1983;;55:323-328.
13 +
Finkelhor RS, Hanak LJ, Behler RC.  Left ventricular filling in endurance-trained subjects. J Am Coll Cardiol . 1986;;8:289-293.
14 +
Fortney S, Tankersley C, Lightfoot JT, et al.  Cardiovascular responses to lower body negative pressure in trained and untrained older men. J Appl Physiol . 1992;;73:2693-2700.
15 +
Fleg JL, Lakatta EG.  Role of muscle loss in the age-associated reduction in V̇o2max. J Appl Physiol . 1988;;65:1147-1151.
16 +
Shock NW, Greulich RC, Andres R, et al.  Normal human aging.  In: The Baltimore Longitudinal Study of Aging . Washington, DC: National Institutes of Health; 1984;:45-57. NIH publication 84-2450.
17 +
Rose GA, Blackburn H. Cardiovascular Survey Methods . Geneva, Switzerland: World Health Organization; 1968;.
18 +
Swinne CJ, Shapiro EP, Lima SD, Fleg JL.  Age-associated changes in cardiac performance during isometric exercise in normal subjects. Am J Cardiol . 1992;;69:823-826.
19 +
Sahn DJ, DeMaria A, Kisslo J, Weyman A.  Recommendation regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation . 1978;;58: 1072-1083.
20 +
Bowman LK, Forrester AL, Jaffee CC, et al.  Peak filling rate normalized to mitral stroke volume: a new Doppler echocardiographic filling index validated by radionuclide angiographic techniques. J Am Coll Cardiol . 1988;;12:937-943.
21 +
Devereux RB, Alonso DR, Lutas EM, et al.  Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol . 1986;;57:450-458.
22 +
Kitzman DW, Sheikh KH, Beere PA, Philips JL, Higginbotham MB.  Age-related alterations of Doppler left ventricular filling indexes in normal subjects are independent of left ventricular mass, heart rate, contractility and loading conditions. J Am Coll Cardiol . 1991;;18:1243-1250.
23 +
Douglas PS, O'Toole ML, Hiller DB, Reichek N.  Left ventricular structure and function by echocardiography in ultraendurance athletes. Am J Cardiol . 1986;;58:805-809.
24 +
Colan SD, Sanders SP, MacPherson D, Borow K.  Left ventricular diastolic function in elite athletes with physiologic cardiac hypertrophy. J Am Coll Cardiol . 1985;;6:545-549.
25 +
Fagard R, van den Broeke C, Bielen E, Vanhees L, Amery A.  Assessment of stiffness of the hypertrophied left ventricle of bicyclists using left ventricular inflow Doppler velocimetry. J Am Coll Cardiol . 1987;;9:1250-1254.
26 +
Shapiro LM, Smith RG.  Effect of training on left ventricular structure and function: an echocardiographic study. Br Heart J . 1983;;50:534-539.
27 +
Granger CB, Karimeddini MK, Smith VE, Shapiro HR, Katz AM, Riba AL.  Rapid ventricular filling in left ventricular hypertrophy, I: physiologic hypertrophy. J Am Coll Cardiol . 1985;;5:862-868.
28 +
Forman DE, Manning WJ, Hauser R, Geruino EV, Evans WJ, Wei JW.  Enhanced left ventricular diastolic filling associated with long-term endurance training. J Gerontol . 1992;;47:M56-M58.
29 +
Takemoto KA, Bernstein L, Lopez JF, Marshak D, Rahimtoola SH, Chandraratna PAN.  Abnormalities of diastolic filling of the left ventricle associated with aging are less pronounced in exercise trained individuals. Am Heart J . 1992;;124: 143-148.
30 +
Douglas PS, O'Toole M.  Aging and physical activity determine cardiac structure and function in the older athlete. J Appl Physiol . 1992;;72:1969-1973.
31 +
Appleton CP.  Influence of incremental changes in heart rate or mitral flow velocity: assessment in lightly sedated, conscious dogs. J Am Coll Cardiol . 1991;;17:227-236.
32 +
Harrison MR, Clifton GD, Pennell AT, DeMaria AN.  Effect of heart rate on left ventricular diastolic transmitted flow velocity patterns assessed by Doppler echocardiography in normal subjects. Am J Cardiol . 1991;;87:622-627.
33 +
Levy WC, Cerqueira MD, Abrass IB, et al.  Endurance exercise training augments diastolic filling at rest and during exercise in healthy young and older men. Circulation . 1993;;88:116-126.
34 +
Schulman SP, Lakatta EG, Fleg JL, Lakatta L, Becker LC, Gerstenblith G.  Age-related decline in left ventricular filling at rest and exercise. Am J Physiol . 1992;;263:H1932-H1938.
35 +
Choong CY, Hermann HC, Weyman AE, Fifer MA.  Preload dependence of Doppler-derived indexes of left ventricular diastolic function in humans. J Am Coll Cardiol . 1987;;10:800-808.
36 +
Stoddard MF, Pearson AC, Kern MJ, Ratchiff J, Mrosek DG, Labovitz AJ.  Influences of alteration in preload on the pattern of left ventricular diastolic filling as assessed by Doppler echocardiology in humans. Circulation . 1989;;79:1226-1236.

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