Left ventricular atrioventricular plane displacement is preserved with lifelong endurance training and is the main determinant of maximal cardiac output

Abstract

Age-related decline in cardiac function can be prevented or postponed by lifelongendurance training. However, effects of normal ageing as well as of lifelong endurance exercise onlongitudinal and radial contribution to stroke volume are unknown. The aim of this study was todetermine resting longitudinal and radial pumping in elderly athletes, sedentary elderly and youngsedentary subjects. Furthermore, we aimed to investigate determinants of maximal cardiac outputin elderly. Eight elderly athletes (63±4 years), seven elderly sedentary (66±4 years) and ten youngsedentary subjects (29±4 years) underwent cardiac magnetic resonance imaging. All subjectsunderwent maximal exercise testing and for elderly subjects maximal cardiac output duringcycling was determined using a dye dilution technique. Longitudinal and radial contribution tostroke volume did not differ between groups (longitudinal left ventricle (LV) 52–65%,P=0.12,right ventricle (RV) 77–87%,P=0.16, radial 7.9–8.6%,P=1.0). Left ventricular atrioventricularplane displacement (LVAVPD) was higher in elderly athletes and young sedentary compared withelderly sedentary subjects (14±3, 15±2and11±1 mm, respectively,P<0.05). There wasno difference between groups for RVAVPD (P=0.2). LVAVPD was an independent predictor ofmaximal cardiac output (R2=0.61,P<0.01,β=0.78). Longitudinal and radial contributions tostroke volume did not differ between groups. However, how longitudinal pumping was achieveddiffered; elderly athletes and young sedentary subjects showed similar AVPD whereas this wassignificantly lower in elderly sedentary subjects.Elderly sedentary subjects achieved longitudinalpumping through increased short-axis area of the ventricle. Large AVPD was a determinant ofmaximal cardiac output and exercise capacity.