The Aging Human Heart
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There seems to be more about aging than living longer.1,2 Certainly, among most humans, longevity is determined by exposure to environmental risk factors that account for morbidity and eventual mortality.3 However, it is not known whether control for most or all environmental risk factors would assure humans unlimited survival. The concept that among members of our species, survival is predetermined biologically remains to be disproven.4 Worldwide, cardiovascular risk factors remain the most important in limiting human survival and burdening human life.5 At the center of the cardiovascular system, how the heart remodels throughout human life is, therefore, of particular importance to our understanding of cardiovascular aging.
See Article by Hung et al
The advent of noninvasive technologies that allowed for the direct assessment of global systolic function in humans led to the important realization that, contrary to what one might intuitively expect, left ventricular (LV) ejection fraction did not decline with aging, particularly when obstructive coronary artery disease was excluded or accounted for in longitudinal cohorts.6 More recent work indicated in fact that the human heart remodels significantly with aging,7 while the LV ejection fraction remains at normal levels. The mechanisms of age-related cardiac remodeling remain incompletely understood, but how and why the aging heart remodels the way it does is of great importance to gaining greater insight into cardiovascular aging.
In this issue of Circulation: Cardiovascular Imaging, Hung et al8 document important findings on human cardiac aging. They demonstrate that advanced aging is associated with greater LV concentricity expressed as the ratio of LV mass to volume at end diastole, impaired relaxation with reduced filling, impaired longitudinal deformation with preserved circumferential shortening, and greater torque, that is, shear in the longitudinal–circumferential plane. Importantly, they also show that this pattern …