Sex, racial differences and healthy aging in normative reference ranges on diastolic function in Ethnic Asians: 2016 ASE guideline revisited

Introduction: However, the reference ranges for echocardiography might be varying due to ethnicity, gender and age. Therefore, the normal reference ranges obtained from the healthy Asians are important for clinical utility of echocardiography in Asia. Methods: Population-based echocardiography dataset from 6,023 healthy ethnic Asians (47.1±10.9 years, 61.3% men) were divided into 6 age decades: ≤29, 30-39, 40-49, 50-59, 60-69 and ≥70 years. We explored age- and sex-related structural/functional alterations according to 2016 American Society of Echocardiography (ASE) diastolic dysfunction (DD) criteria and their correlates with clinical N-terminal pro-brain natriuretic peptide (NT-proBNP) cut-off for heart failure (HF). Racial comparisons were made using data from London Life Sciences Prospective Population (LOLIPOP) study. Results: Age- and sex-based normative reference ranges (including mean, median, 10% and 90% lower and upper reference values) were extracted from our large healthy population. In fully adjusted models, advanced age (treated as linear) was independently associated with cardiac structural remodeling and worsened diastolic parameters: larger indexed LA volume (LAVi), lower e’, higher E/e’, and higher TR velocity; all p <0.001), and were broadly more prominent in women (P interaction : <0.05). in general, markedly lower e’, higher E/e’ and smaller LAVi were observed in ethnic Asians compared to Whites. DD defined by 2016 ASE criteria, despite at low prevalence (0.42%) in current healthy population, increased drastically with advanced age and performed perfectly in excluding abnormal NT-proBNP (≥125 pg/ml) (Specificity: 99.8%, NPV: 97.6%). Conclusions: This is to date the largest cohort exploring the normative reference values using guideline-centered diastolic parameters from healthy Asians, with senescence process played as central role in diastolic dysfunction. Observed sex and ethnic differences in defining healthy diastolic cut-offs likely impact future clinical definition for DD.

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Mitral flow propagation velocity in non-sedated healthy cats

Arquivo Brasileiro de Medicina Veterinária e Zootecnia ◽

10.1590/s0102-09352014000100003 ◽

2014 ◽

Vol 66 (1) ◽

pp. 15-21

Author(s):

A.C. Silva ◽

R.A.L. Muzzi ◽

G. Oberlender ◽

L.A.L. Muzzi ◽

M.R. Coelho ◽

...

Keyword(s):

Diastolic Function ◽

Propagation Velocity ◽

Small Animal ◽

Left Ventricular Diastolic Function ◽

Left Ventricular ◽

Reference Ranges ◽

Mitral Flow ◽

Flow Propagation Velocity ◽

Flow Propagation ◽

Ventricular Filling

Mitral flow propagation velocity (Vp) is an index used to evaluate the left ventricular diastolic function. Its influence on human and small animal cardiopathies has been studied; however there are few reports evaluating this variable in domestic felines. In addition, there is a lack of studies in non-sedated healthy cats. Therefore, the purpose of this study was to establish values for Vp and its correlation with other echocardiographic indexes in non-sedated healthy cats in order to provide new perspectives related to diastolic function in this species. Twenty-six clinically healthy cats were submitted to echocardiography to assess the animals' cardiac conditions. Variables such as age, heart rate (HR), body surface area (BSA), initial (E mitral) and late (A mitral) ventricular filling waves, isovolumic relaxation time (IVRT) and E/IVRT relation were correlated to Vp. No proven relation between any of these variables and Vp was observed in this present study, except for HR and BSA. In the variability analysis, higher values were verified for inter-observer analysis. This study concludes that Vp proved to be an useful index for estimating left ventricular relaxation in non-sedated healthy domestic cats and provides reference ranges for this variable.

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Correlation between non-invasive myocardial work indices and main parameters of systolic and diastolic function: results from the EACVI NORRE study

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez203 ◽

2019 ◽

Vol 21 (5) ◽

pp. 533-541 ◽

Cited By ~ 7

Author(s):

Roberta Manganaro ◽

Stella Marchetta ◽

Raluca Dulgheru ◽

Tadafumi Sugimoto ◽

Toshimitsu Tsugu ◽

...

Keyword(s):

Diastolic Function ◽

Global Longitudinal Strain ◽

Myocardial Strain ◽

Multivariable Analysis ◽

Radial Strain ◽

Reference Ranges ◽

Non Invasive ◽

Beta Coefficient ◽

Global Work ◽

Systolic And Diastolic Function

Abstract Aims The present study sought to evaluate the correlation between indices of non-invasive myocardial work (MW) and left ventricle (LV) size, traditional and advanced parameters of LV systolic and diastolic function by 2D echocardiography (2DE). Methods and results A total of 226 (85 men, mean age: 45 ± 13 years) healthy subjects were enrolled at 22 collaborating institutions of the Normal Reference Ranges for Echocardiography (NORRE) study. Global work index (GWI), global constructive work (GCW), global work waste (GWW), and global work efficiency (GWE) were estimated from LV pressure-strain loops using custom software. Peak LV pressure was estimated non-invasively from brachial artery cuff pressure. LV size, parameters of systolic and diastolic function and ventricular-arterial coupling were measured by echocardiography. As advanced indices of myocardial performance, global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were obtained. On multivariable analysis, GWI was significantly correlated with GLS (standardized beta-coefficient = −0.23, P < 0.001), ejection fraction (EF) (standardized beta-coefficient = 0.15, P = 0.02), systolic blood pressure (SBP) (standardized beta-coefficient = 0.56, P < 0.001) and GRS (standardized beta-coefficient = 0.19, P = 0.004), while GCW was correlated with GLS (standardized beta-coefficient = −0.55, P < 0.001), SBP (standardized beta-coefficient = 0.71, P < 0.001), GRS (standardized beta-coefficient = 0.11, P = 0.02), and GCS (standardized beta-coefficient = −0.10, P = 0.01). GWE was directly correlated with EF and inversely correlated with Tei index (standardized beta-coefficient = 0.18, P = 0.009 and standardized beta-coefficient = −0.20, P = 0.004, respectively), the opposite occurred for GWW (standardized beta-coefficient =−−0.14, P = 0.03 and standardized beta-coefficient = 0.17, P = 0.01, respectively). Conclusion The non-invasive MW indices show a good correlation with traditional 2DE parameters of myocardial systolic function and myocardial strain.

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Testosterone and Estrone Increase From the Age of 70 Years: Findings From the Sex Hormones in Older Women Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2019-00743 ◽

2019 ◽

Vol 104 (12) ◽

pp. 6291-6300 ◽

Cited By ~ 10

Author(s):

Susan R Davis ◽

Robin J Bell ◽

Penelope J Robinson ◽

David J Handelsman ◽

Tom Gilbert ◽

...

Keyword(s):

Older Women ◽

Healthy Aging ◽

Reference Group ◽

Overweight And Obesity ◽

Sex Steroid ◽

Specific Reference ◽

Normal Body Mass Index ◽

Reference Ranges ◽

Cross Sectional ◽

Liquid Chromatography Tandem Mass

Abstract Context There is a lack of understanding of what is normal in terms of sex steroid levels in older women. Objective To determine whether sex steroid levels vary with age in and establish reference ranges for women >70 years of age. Design and Setting Cross-sectional, community-based study. Participants Included 6392 women ≥70 years of age. Main Outcome Measures Sex steroids measured by liquid chromatography–tandem mass spectrometry. A reference group, to establish sex steroid age-specific reference ranges, excluded women using systemic or topical sex steroid, antiandrogen or glucocorticoid therapy, or an antiglycemic agent. Results The reference group of 5326 women had a mean age of 75.1 (±4.2) years, range of 70 to 94.7 years. Median values (range) were 181.2 pmol/L (3.7 to 5768.9) for estrone (E1), 0.38 nmol/L (0.035 to 8.56) for testosterone (T), 2.60 nmol/L (0.07 to 46.85) for dehydroepiandrosterone (DHEA), and 41.6 nmol/L (2.4 to 176.6) for SHBG. Estradiol and DHT were below method sensitivity in 66.1% and 72.7% of the samples, respectively. Compared with women aged 70 to 74 years, women aged ≥85 years had higher median levels of E1 (11.7%, P = 0.01), T (11.3%, P = 0.02), and SHBG (22.7%, P < 0.001) and lower DHEA (30% less, P < 0.001). Women with overweight and obesity had higher E1 (P < 0.001) and T (P < 0.03) and lower SHBG (P < 0.001) than did women with normal body mass index. Smokers had 17.2% higher median T levels (P = 0.005). Conclusion From the age of 70 years, T and E1 increase with age, despite a steady decline in DHEA. Whether E1 and T are biomarkers for longevity or contribute to healthy aging merits investigation.

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SOCIOCULTURAL DETERMINANTS OF RACIAL HEALTH DISPARITIES ACROSS THE LIFECOURSE

Innovation in Aging ◽

10.1093/geroni/igz038.2191 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S590-S591

Author(s):

Nancy Chiles Shaffer ◽

Carl V Hill

Keyword(s):

Health Disparities ◽

Racial Differences ◽

Social Determinants ◽

Healthy Aging ◽

Financial Burden ◽

Large Body ◽

Sociocultural Factors ◽

Racial Health Disparities ◽

Race And Gender ◽

And Gender

Abstract Racial health disparities have been observed across the lifecourse. While some studies have attributed these disparities to underlying biomedical differences, a large body of research supports a sociocultural etiology. In this symposium we will demonstrate that observed racial differences in health outcomes are associated with sociocultural factors, and demonstrate effective strategies for assessing race and racial differences in qualitative and quantitative analyses. We will share an overview of health disparities and aging, highlighting the National Institute on Aging’s Health Disparities Research Framework. After this introduction, four speakers will present scientific projects that exemplify the breadth and depth of research assessing health disparities and social determinants of health across the lifecourse. Dr. Brown will present qualitative work on how social determinants are positively addressed through exercise. Dr. Chiles Shaffer will present findings demonstrating the contribution of financial burden and lower education to racial differences in healthy aging. Dr. Noppert will present evidence highlighting the structural influences that underlie the association between education and metabolic health focusing on differences by race and gender. Dr. Thierry will present research on the association between neighborhood characteristics and telomere length with a focus on heterogeneity by race and urban/non-urban residence. Finally, Dr. Hill will provide an overview of the four presentations and facilitate questions and discussion.

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THE HIGH COST OF SOCIOECONOMICS ON RACIAL DISPARITIES IN HEALTHY AGING

Innovation in Aging ◽

10.1093/geroni/igz038.2193 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S591-S591

Author(s):

Nancy Chiles Shaffer

Keyword(s):

Racial Differences ◽

Low Socioeconomic Status ◽

Healthy Aging ◽

Future Research ◽

Mineral Density ◽

Low Socioeconomic ◽

Black And White ◽

Aging Index ◽

Health Aging ◽

Using Data

Abstract Race-related differences in overall health across the age-span are well established; how differences manifest within a cohort selected for good functional status is unclear. Using data from Black and White older adults aged 70-79, in the Health, Aging and Body Composition (Health ABC) study, we created a healthy aging index (HAI) of mental health, fitness, lung capacity, bone mineral density, inflammation, and metabolic syndrome. We assessed if racial differences existed in HAI, the extent education, financial resources and stress attenuated any observed differences, and whether this varied by site (Memphis v. Pittsburgh). Blacks had lower HAI than whites, adjusted for age and site. Further adjustment for finances and education eliminated the effect of race in women and reduced the effect in men by 64%. A significant interaction between site and financial stress was observed. Future research should assess ways to reduce the harmful impact of low socioeconomic status on health.

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