Aortic flow is associated with aging and exercise capacity

Zhao, Xiaodan, Garg, Pankaj ORCID:, Assadi, Hosamadin ORCID:, Tan, Ru San, Chai, Ping, Yeo, Tee Joo, Matthews, Gareth ORCID:, Mehmood, Zia, Leng, Shuang, Bryant, Jennifer Ann, Teo, Lynette L. S., Ong, Ching Ching, Yip, James W., Tan, Ju Le, van der Geest, Rob J. and Zhong, Liang (2023) Aortic flow is associated with aging and exercise capacity. European Heart Journal, 3 (4). ISSN 0195-668X

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Aims: Increased blood flow eccentricity in the aorta has been associated with aortic (AO) pathology, however, its association with exercise capacity has not been investigated. This study aimed to assess the relationships between flow eccentricity parameters derived from 2-dimensional (2D) phase-contrast (PC) cardiovascular magnetic resonance (CMR) imaging and aging and cardiopulmonary exercise test (CPET) in a cohort of healthy subjects.   Methods and Results: One hundred and sixty-nine healthy subjects (age 44 ± 13 years, M/F: 96/73) free of cardiovascular disease were recruited in a prospective study (NCT03217240) and underwent CMR, including 2D PC at an orthogonal plane just above the sinotubular junction, and CPET (cycle ergometer) within one week. The following AO flow parameters were derived: AO forward and backward flow indexed to body surface area (FFi, BFi), average flow displacement during systole (FDsavg), late systole (FDlsavg), diastole (FDdavg), systolic retrograde flow (SRF), systolic flow reversal ratio (sFRR), and pulse wave velocity (PWV). Exercise capacity was assessed by peak oxygen uptake (PVO2) from CPET. The mean values of FDsavg, FDlsavg, FDdavg, SRF, sFRR, and PWV were 17 ± 6%, 19 ± 8%, 29 ± 7%, 4.4 ± 4.2 mL, 5.9 ± 5.1%, and 4.3 ± 1.6 m/s, respectively. They all increased with age (r = 0.623, 0.628, 0.353, 0.590, 0.649, 0.598, all P < 0.0001), and decreased with PVO2 (r = −0.302, −0.270, −0.253, −0.149, −0.219, −0.161, all P < 0.05). A stepwise multivariable linear regression analysis using left ventricular ejection fraction (LVEF), FFi, and FDsavg showed an area under the curve of 0.769 in differentiating healthy subjects with high-risk exercise capacity (PVO2 ≤ 14 mL/kg/min).   Conclusion: AO flow haemodynamics change with aging and predict exercise capacity.

Item Type: Article
Additional Information: Funding information: This study received funding support from the National Medical Research Council of Singapore (grant numbers NMRC/OFIRG/0018/2016, MOH-000358, MOH-000351). PG is funded by Wellcome Trust Clinical Research Career Development Fellowship (220703/Z/20/Z). For the purpose of Open Access, these authors have applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. The funders had no role in study design, data collection and analysis, publishing decisions, or manuscript preparation.
Uncontrolled Keywords: 2d phase-contrast,aortic flow,cardiopulmonary exercise testing,flow displacement,haemodynamics,cardiology and cardiovascular medicine,surgery,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/2700/2705
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health
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Depositing User: LivePure Connector
Date Deposited: 07 Sep 2023 11:30
Last Modified: 19 Oct 2023 03:39
DOI: 10.1093/ehjopen/oead079


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