P5581In patients with aortic valve regurgitation, left ventricular geometry and strain, more than pulmonary artery systolic pressure, affect right ventricular function

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Abdelgawad ◽  
M A Abdelhay ◽  
S Ashour ◽  
M Shehata ◽  
M Previato ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
Sphericity Index ◽  
End Systolic Volume ◽  
Rv Function

Abstract Background Left ventricular (LV) overload due to aortic valve (AR) regurgitation may affect right ventricular (RV) function. Elevation of pulmonary artery pressures secondary to isolated AR is not common. Thus, the effects of chronic LV overload due to AR on RV function remains to be clarified. Purpose To assess the determinants of RV dysfunction in chronic AR. Methods We studied 36 patients with moderate or severe AR (53±18 years, 81% were men). We used 3D echocardiography to acquire multi-beat, full-volume data sets of LV and RV and to measure volumes and EF. RV fractional area change (FAC) was calculated. LV global longitudinal strain (GLS) and RV peak longitudinal strain (RVLS) were assessed by 2D speckle tracking echocardiography. Results RV EF and RV FAC were 40±6% and 34±9%. LV GLS and peak RVLS were reduced (Table). LV EDVi showed negative correlations with RV function (RV EF: r=−0.545, p<0.001; RV FAC: r=−0.816, p<0.001). LV sphericity index showed negative correlations with RV function (RVFAC: r=−0.608, P=0.001; RV EF: r=−0.469, P=0.004). Moreover, LV GLS and RVLS correlated positively with RV function (FAC: for GLS: r=0.475, p=0.003 and for RVLS: r=0.389, p=0.019) (RV EF: for GLS: r=0.526, p=0.001 and for RVLS: r=0.475, p=0.003). On multivariable linear regression analysis, LV EDVi, LV sphericity index, LV GLS and peak RVLS were found to be the only independent predictors of RV EF and FAC. Left and right ventricular volumes and function in patients with chronic aortic regurgitation AR (n=36) Control (n=25) p value LV end-diastolic volume (ml/m2) 106±36 56±8 <0.001 LV end-systolic volume (ml/m2) 50±28 22±4 <0.001 LV ejection fraction (%) 54±10 60±4 <0.001 LV sphericity index 0.53±0.11 0.38±0.08 <0.001 Pulmonary artery systolic pressure (mm Hg) 27±8 RV end-diastolic volume (ml/m2) 59±12 35±7 <0.001 RV end-systolic volume (ml/m2) 31±9 17±3 <0.001 RV ejection fraction (%) 40±6 50±4 <0.001 RV fractional area change (%) 34±9 44±6 <0.001 LV GLS (%) −18±3 21±1 <0.001 Peak RVLS (%) −26±5 −31±3 <0.001 Conclusions RV remodeling in chronic LV overload due to AR occurs independent on PASP values. LV size, shape and strain are the only independent predictors of RV function.

scholarly journals Echocardiography of right ventricular-arterial coupling predicts survival of elderly patients with heart failure and reduced to mid-range ejection fraction

2020 ◽  
Vol 90 (2) ◽  
Author(s):  
Gian Marco Rosa ◽  
Andreina D'Agostino ◽  
Stefano Giovinazzo ◽  
Giovanni La Malfa ◽  
Paolo Fontanive ◽  
...  
Keyword(s):  
Ejection Fraction ◽  
Right Ventricular ◽  
Ace Inhibitor ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Volume Index ◽  
Systolic Volume ◽  
End Systolic Volume ◽  
And Gender ◽  
The Impact

Echocardiography of right ventricular (RV)-arterial coupling obtained by the estimation of the ratio of the longitudinal annular systolic excursion of the tricuspid annular plane and pulmonary artery systolic pressure (TAPSE/PASP) has been found to be a remarkable prognostic indicator in patients with HF. Our aim was to evaluate the impact of TAPSE, PASP and their ratio in the prognostic stratification of outpatients with HF aged ≥70 years and reduced to mid-range ejection fraction (EF). A complete echocardiographic examination was performed in 400 outpatients with chronic HF and left ventricular (LV) EF ≤50% who averaged 77 years in age. During a median follow-up period of 25 months (interquartile range: 8-46), there were 135 cardiovascular deaths. Two different Cox regression models were evaluated, one including TAPSE and PASP, separately, and the other with TAPSE/PASP. In the first model, LV end-systolic volume index, age, no angiotensin converting enzyme (ACE) inhibitor use, TAPSE, PASP and gender were found to be independently associated with the outcome after adjustment for demographics, clinical, biochemical, echocardiographic data. In the second model, TAPSE/PASP resulted the most important independent predictor of outcome (hazard ratio [HR]:0.07, p<0.0001) followed by LV end-systolic volume index, no ACE inhibitor use, age and gender. The use of the variable TASPE/PASP improved the predictive value of the new multivariable model (area under the curve [AUC] of 0.74 vs AUC of 0.71; p<0.05). TASPE/PASP improved the net reclassification (NRI = 14.7%; p<0.01) and the integrated discrimination (IDI = 0.04; p<0.01). In conclusion, the study findings showed that assessment of RV-arterial coupling by TAPSE/PASP was of major importance to assess the prognosis of patients with chronic HF and LV EF ≤50% aged ≥70 years.

Dimensional analysis of the left ventricle: effects of acute aortic regurgitation

1975 ◽  
Vol 228 (2) ◽  
pp. 536-542 ◽  
Author(s):  
SJ Leshin ◽  
LD Horwitz ◽  
JH Mitchell
Keyword(s):  
Left Ventricle ◽  
Aortic Regurgitation ◽  
Diastolic Pressure ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Systolic Volume ◽  
Severe Aortic Regurgitation ◽  
End Diastolic Volume ◽  
Catheter Technique ◽  
End Systolic Volume

The effects of acute severe aortic regurgitation on the left ventricle were investigated in conscious, chronically instrumented dogs. Left ventricular dimensions and volumes were measured from biplane cineradiographs of beads positioned near the endocardium. Data were collected before and after the production of aortic regurgitation by a catheter technique. The aortic regurgitation resulted in increases in mean aortic pulse pressure from 44 to 73 mmHg (P smaller than 0.001), heart rate from 87 to 122 beats/min (P smaller than 0.02), and left ventricular end-diastolic pressure from 11 to 25 mmHg (P smaller than 0.05). Mean end-diastolic volume rose from 61 to 69 cc (P smaller than 0.001), while end-systolic volume remained unchanged at 37 cc. The end-diastolic dilatation following regurgitation was asymmetrical in that the increase in size was due principally to an increase in the septal-lateral axis. The acute volume load of aortic regurgitation was accomplished by an increase in end-diastolic volume, i.e., the Frank-Starling mechanism. The tachycardia probably reflects augmented cardiac sympathetic activity, but the constant end-systolic volume at a similar mean systolic pressure suggests that the net contractile state was unchanged.

scholarly journals Sleep disordered breathing and enlargement of the right heart after myocardial infarction

2014 ◽  
Vol 45 (3) ◽  
pp. 680-690 ◽  
Author(s):  
Stefan Buchner ◽  
Michael Eglseer ◽  
Kurt Debl ◽  
Andrea Hetzenecker ◽  
Andreas Luchner ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Right Ventricular ◽  
Sleep Disordered Breathing ◽  
Left Ventricular ◽  
Right Atrial ◽  
Right Heart ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
End Systolic Volume ◽  
The Right

Structural and functional integrity of the right heart is important in the prognosis after acute myocardial infarction (AMI). The objective of this study was to assess the impact of sleep disordered breathing (SDB) on structure and function of the right heart early after AMI.54 patients underwent cardiovascular magnetic resonance 3–5 days and 12 weeks after AMI, and were stratified according to the presence of SDB, defined as an apnoea–hypopnoea index of ≥15 events·h−1.12 weeks after AMI, end-diastolic volume of the right ventricle had increased significantly in patients with SDB (n=27)versusthose without (n=25) (mean±sd14±23%versus0±17%, p=0.020). Multivariable linear regression analysis accounting for age, sex, body mass index, smoking, left ventricular mass and left ventricular end-systolic volume showed that the apnoea–hypopnoea index was significantly associated with right ventricular end-diastolic volume (B-coefficient 0.315 (95% CI 0.013–0.617); p=0.041). From baseline to 12 weeks, right atrial diastolic area increased more in patients with SDB (2.9±3.7 cm2versus1.0±2.4 cm2, p=0.038; when adjusted for left ventricular end systolic volume, p=0.166).SDB diagnosed shortly after AMI predicts an increase of right ventricular end-diastolic volume and possibly right atrial area within the following 12 weeks. Thus, SDB may contribute to enlargement of the right heart after AMI.

Effect of vasopressin on left ventricular performance

1993 ◽  
Vol 264 (1) ◽  
pp. H53-H60
Author(s):  
C. P. Cheng ◽  
Y. Igarashi ◽  
H. S. Klopfenstein ◽  
R. J. Applegate ◽  
Z. Shihabi ◽  
...  
Keyword(s):  
Systolic Pressure ◽  
Left Ventricular ◽  
Systemic Resistance ◽  
Stroke Work ◽  
Arterial Elastance ◽  
Ventricular Performance ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
End Systolic Volume ◽  
The Right

We assessed the effect of arginine vasopressin (AVP) on left ventricular (LV) performance in eight conscious dogs. Five minutes after AVP infusion (6 microns.kg-1 x min-1 for 2 min) the plasma AVP was elevated from 3.9 +/- 0.9 to 14.7 +/- 4.6 pg/ml (P < 0.05). With all reflexes intact, AVP caused significant increases in LV end-systolic pressure (P) (112 +/- 8 vs. 122 +/- 7 mmHg, P < 0.05) end-systolic volume (V) (30 +/- 5.8 vs. 38 +/- 7.7 ml, P < 0.05), total systemic resistance (6.2 +/- 1.8 vs. 10.6 +/- 4.0 mmHg.dl-1 x min, P < 0.01) and arterial elastance (Ea) (6.8 +/- 3.0 vs. 8.6 +/- 3.9 mmHg/ml, P < 0.05), while the heart rate (110 +/- 6 vs. 82 +/- 10 beats/min, P < 0.05) and stroke volume (16.5 +/- 4.3 vs. 14.2 +/- 3.9 ml, P < 0.05) were decreased. There was no significant change in the coronary sinus blood flow (82 +/- 19 vs. 78 +/- 22 ml/min, P = not significant). AVP decreased the slopes of LV end-systolic P-V relation (10.7 +/- 1.1 vs. 8.1 +/- 1.9 mmHg/ml, P < 0.05), the maximal first derivative of LV pressure (dP/dtmax)-end-diastolic volume (VED) relation (135.2 +/- 18.7 vs. 63.1 +/- 7.7 mmHg.s-1 x ml-1, P < 0.05), and the stroke work-VED relation (81.1 +/- 4.1 vs. 66.7 +/- 2.8 mmHg, P < 0.05) and shifted the relations to the right, indicating a depression of LV performance. A similar increase in Ea produced by methoxamine did not depress LV performance.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Three-Dimensional Right Ventriculo-Arterial Coupling as an Independent Correlate of Severe Heart Failure Symptoms in Patients with Dilated Cardiomyopathy

2021 ◽  
Author(s):  
Aura Vijiiac ◽  
Sebastian Onciul ◽  
Silvia Deaconu ◽  
Radu Vatasescu ◽  
Claudia Guzu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Dilated Cardiomyopathy ◽  
Three Dimensional ◽  
Severe Heart Failure ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Pulmonary Artery Systolic Pressure ◽  
Characteristic Analysis

Background: Right ventricular-pulmonary artery coupling (RVPAC) is a predictor of outcome in pulmonary hypertension. However, the role of this parameter in dilated cardiomyopathy (DCM) remains to be established. The aim of this study was to assess the contribution of RVPAC to the occurrence of severe heart failure (HF) symptoms in patients with DCM using three-dimensional (3D) echocardiography. Methods: We prospectively screened 139 outpatients with DCM, 105 of whom were enrolled and underwent 3D echocardiographic assessment. RVPAC was estimated non-invasively as the 3D right ventricular stroke volume (SV) to end-systolic volume (ESV) ratio. Severe HF symptoms were defined by New York Heart Association (NYHA) class III or IV. We evaluated differences in RVPAC across NYHA classes and the ability of RVPAC to predict severe symptoms. Results: Mean left ventricular (LV) ejection fraction was 28±7%. Mean RVPAC was 0.77±0.30 and it was significantly more impaired with increasing symptom severity (p=0.001). RVPAC was the only independent correlate of severe HF symptoms, after adjusting for age, diuretic use, LV systolic function, LV diastolic function and pulmonary artery systolic pressure (OR 0.035 [95% CI, 0.004 – 0.312], p=0.003). By receiver-operating characteristic analysis, the RVPAC cut-off value for predicting severely symptomatic status was 0.54 (area under the curve=0.712, p<0.001). Conclusion: 3D echocardiographic SV/ESV ratio is an independent correlate of severe HF symptoms in patients with DCM. 3D RVPAC might prove to be a useful risk stratification tool for these patients, should it be further validated in larger studies.

Abstract 307: Poor Right Ventricular Systolic Function (lower TAPSE) and Higher Pulmonary Artery Systolic Pressure (PASP) Predicts Early Readmissions and all Cause Mortality in Elderly Patients with Heart Failure

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Gunjan Choudhary ◽  
Umashankar Lakshmanadoss ◽  
Hari Prasad ◽  
Zaruhi Babayan ◽  
Dwight Stapleton
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Elderly Patients ◽  
Right Ventricular ◽  
Systolic Dysfunction ◽  
Systolic Pressure ◽  
Pulmonary Artery Systolic Pressure ◽  
All Cause Mortality ◽  
Early Readmission ◽  
Rv Function

Background: Heart failure(HF) related early readmission (<30days) and mortality is higher in elderly patients. Right ventricular (RV) dysfunction is associated with worse prognosis in patients with HF with reduced ejection fraction (HFrEF). We evaluated effect of RV function (as measured by TAPSE - Tricuspid annular plane systolic excursion) and Pulmonary artery systolic pressure (PASP) on early HF readmission and mortality in elderly HF patients. Methods: This is single center observational study of elderly (≥65 years )patients with HFrEF. Patients with principal discharge diagnosis of HFrEF are included (n = 278, age 77 ± 9 years, 38% female, LVEF 29% ± 9%). Demographic and echocardiographic data are collected. TAPSE (as a marker of RV systolic dysfunction) and PASP are measured as per ASE guidelines. Prediction models are performed. Results: Among 278 patients, 62 patients ( 22.3%) had HF related early readmission and 123 patients (44%) died at the end of 5 year. On univariate analysis, older age, Hypertension, Diabetes, higher PASP , RV systolic dysfunction (TAPSE <16mm) and BMI< 25 are predictors of early readmission and mortality (P value <0.05). On multivariate logistic regression analysis, early HF readmission was predicted by TAPSE <16 mm (OR=23.6; p < 0.001; CI 10.23-54.60) and PASP >50 mmHg ( OR = 34; p < 0.001; 95 CI 14.08-82.81); five year all cause mortality was predicted by TAPSE < 16mm (OR = 1.85; p 0.023; 95 CI 1.08-3.16) and PASP >50 mmHg (OR = 2.11; p 0.009; 95 CI 1.19-3.72). Conclusion: TAPSE <16 mm and PASP >50 mmHg are strong predictors of early readmission and five year all cause mortality in elderly HF patients. The assessment of RV function through TAPSE and PASP, helps to risk-stratify elderly patients with HFrEF.

Abstract 15011: Association of Pulmonary Hemodynamics and Right Ventricular Function With Incident Atrial Fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Romil R Parikh ◽  
Faye L Norby ◽  
Wendy Wang ◽  
Thenappan Thenappan ◽  
Kurt W Prins ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Right Ventricular ◽  
Systolic Pressure ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Volume Index ◽  
Pulmonary Artery Systolic Pressure ◽  
Pulmonary Hemodynamics ◽  
Functional Remodeling ◽  
Rv Function

Introduction: Higher pulmonary artery systolic pressure (PASP) and right ventricular (RV) dysfunction are associated with higher risk of heart failure (HF) and mortality. Whether higher PASP and lower RV function are associated with risk of atrial fibrillation (AF) is unclear. Hypothesis: Higher PASP, higher pulmonary vascular resistance (PVR), and lower RV function are associated with incident AF after accounting for left atrial (LA) size and function, and left ventricular (LV) systolic and diastolic function. Methods: ARIC participants free of prevalent coronary heart disease (CHD), HF, AF, and with LA volume index (LAVi) <34ml/m 2 and average E/e’ ratio <14 in 2011-13 were included. We measured PASP, PVR, RV fractional area change (RVFAC), and RV-PA coupling (defined as RVFAC/PASP ratio) from 2D-echocardiograms. Incident AF (through 2018) was ascertained from hospital discharge codes and death certificates. We used Cox proportional hazards regression in our analysis. Results: We included 1915 participants (mean age 75 years, 69% female, 24% black) of whom 176 developed AF over a median follow-up of 6.3 years. PASP, PVR, and RV-PA coupling were significantly associated with incident AF after adjusting for measures of LA and LV structural and functional remodeling. RVFAC was not significantly associated with incident AF. Conclusions: In persons without CHD, HF, and LA enlargement, higher PASP and lower RV-PA coupling are associated with higher risk of AF after accounting for LA and LV structural and functional remodeling. This finding, which suggests a possible etiological role of RV remodeling for AF, needs further confirmation.

Ejecting deactivation does not affect O2 consumption-pressure-volume area relation in dog hearts

1993 ◽  
Vol 265 (3) ◽  
pp. H934-H942 ◽  
Author(s):  
O. Kawaguchi ◽  
Y. Goto ◽  
S. Futaki ◽  
Y. Ohgoshi ◽  
H. Yaku ◽  
...  
Keyword(s):  
Mechanical Energy ◽  
Systolic Pressure ◽  
Pressure Rise ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Generation Process ◽  
Ejection Velocity ◽  
Systolic Volume ◽  
End Diastolic Volume ◽  
End Systolic Volume

We studied the effects of ejection velocity and resistive properties of the left ventricle (LV) on myocardial oxygen consumption (VO2) in 13 excised cross-circulated dog hearts. Increases in peak ejection velocity (-dV/dt) from 4.0 +/- 1.3 (SD) end-diastolic volume (EDV)/s to 12.7 +/- 5.3 EDV/s with constant EDV and end-systolic volume (velocity run) induced systolic pressure deficit. This decreased pressure-volume area (PVA; a measure of ventricular mechanical energy) and LV end-systolic elastance (Emax) by 47 +/- 14 and 38 +/- 15%, respectively. Unchanged maximum rate of left ventricular pressure rise and time-varying elastance during the isovolumic contraction period at the same EDV indicated that these contractions started with the same contractile state although the quicker ejection caused the greater deactivation. If the PVA deficit due to systolic pressure deficit is attributable to an internal energy-dissipating resistive element, VO2 in the velocity run will not as much decrease in proportion to PVA as in the isovolumic or slowly ejecting control run. However, the decreases in PVA due to increased -dV/dt decreased VO2 to the same extent as in the control run. This result negated the possibility that the pressure and PVA deficits would be caused by a mechanical energy-losing process. The same results were obtained whether or not Emax was decreased by quick ejection. We conclude that the pressure and PVA deficits and the proportionally decreased VO2 during quick ejection are mainly attributable to suppression of a ventricular mechanical energy generation process, but not of mechanical energy-losing process, by ejecting deactivation.

Effects of reduced resistive afterload on left ventricular pressure-volume relationship

1985 ◽  
Vol 248 (2) ◽  
pp. H163-H169
Author(s):  
J. Ducas ◽  
U. Schick ◽  
L. Girling ◽  
R. M. Prewitt
Keyword(s):  
Systolic Pressure ◽  
Left Ventricular Pressure ◽  
Left Ventricular ◽  
Ventricular Pressure ◽  
Base Line ◽  
Resistive Load ◽  
Systolic Volume ◽  
Arteriovenous Fistulas ◽  
End Diastolic Volume ◽  
End Systolic Volume

In seven anesthetized, beta-blocked dogs, we investigated the effects of a reduction in systemic vascular resistance (SVR) on left ventricular (LV) systolic mechanics. LV pressure and volumes (scintigraphic techniques) were measured in base-line condition, after opening one and then two arteriovenous fistulas (AVF). Volume was infused to maintain LV end-systolic pressure (LVESP). Despite a constant ESP, the mean end-systolic volume (LVESV) fell from 42 to 31 ml (P less than 0.025) when the SVR fell from 81 to 48 units (P less than 0.0025), and the LVESV fell further to 24 ml (P less than 0.0025) when the SVR was decreased to 30 units (P less than 0.025). In six similarly prepared dogs, aortic flow was measured, and when resistive afterload decreased, instantaneous flow increased. Since end-diastolic volume was not significantly changed when resistive afterload decreased, instantaneous LV volume decreased despite constant systolic LV pressure. In two of these dogs, LV pressure-volume (PV) trajectories were drawn for the ejection period. When SVR decreased there was a marked leftward shift of the PV trajectory as the end of ejection was approached. It is concluded that at a given contractile state and ventricular pressure, alterations in resistive load directly affect rate and extent of ventricular shortening.

scholarly journals Age matters: differences in exercise-induced cardiovascular remodelling in young and middle aged healthy sedentary individuals

2020 ◽  
pp. 204748732092630
Author(s):  
Camilla Torlasco ◽  
Andrew D’Silva ◽  
Anish N Bhuva ◽  
Andrea Faini ◽  
Joao B Augusto ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Right Ventricular ◽  
Left Ventricular ◽  
Systolic Volume ◽  
Non Invasive ◽  
End Diastolic Volume ◽  
End Systolic Volume ◽  
Unsupervised Training ◽  
Exercise Induced ◽  
First Time

Aims Remodelling of the cardiovascular system (including heart and vasculature) is a dynamic process influenced by multiple physiological and pathological factors. We sought to understand whether remodelling in response to a stimulus, exercise training, altered with healthy ageing. Methods A total of 237 untrained healthy male and female subjects volunteering for their first time marathon were recruited. At baseline and after 6 months of unsupervised training, race completers underwent tests including 1.5T cardiac magnetic resonance, brachial and non-invasive central blood pressure assessment. For analysis, runners were divided by age into under or over 35 years (U35, O35). Results Injury and completion rates were similar among the groups; 138 runners (U35: n = 71, women 49%; O35: n = 67, women 51%) completed the race. On average, U35 were faster by 37 minutes (12%). Training induced a small increase in left ventricular mass in both groups (3 g/m2, P < 0.001), but U35 also increased ventricular cavity sizes (left ventricular end-diastolic volume (EDV)i +3%; left ventricular end-systolic volume (ESV)i +8%; right ventricular end-diastolic volume (EDV)i +4%; right ventricular end-systolic volume (ESV)i +5%; P < 0.01 for all). Systemic aortic compliance fell in the whole sample by 7% ( P = 0.020) and, especially in O35, also systemic vascular resistance (–4% in the whole sample, P = 0.04) and blood pressure (systolic/diastolic, whole sample: brachial –4/–3 mmHg, central –4/–2 mmHg, all P < 0.001; O35: brachial –6/–3 mmHg, central –6/–4 mmHg, all P < 0.001). Conclusion Medium-term, unsupervised physical training in healthy sedentary individuals induces measurable remodelling of both heart and vasculature. This amount is age dependent, with predominant cardiac remodelling when younger and predominantly vascular remodelling when older.

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