老年心脏的功能不亚于青年心脏

以前,大家对老年人的重大偏见之一是老年人心脏对运动的(耐受)能力显著降低。但约翰斯·霍普金斯大学的Myron Weisfeldt说,如果你选择正常健康的老年人作实验,就会得出老年人对最大运动量的心血管反应并不衰退。但这不等于说,老年心脏与青年心脏毫无区别。Weisfeldt解释说:“老年心脏的功能不亚于青年心脏,但是,两者的工作方法不同。”     

老化认知神经科学:研究现状与未来展望

人口老龄化已经成为我国乃至全球面临的一个严峻的社会问题.开展老化认知神经科学研究,从认知、脑结构和脑功能层面揭示脑老化的机制和规律,进而探索并开发出延缓认知下降的方法和工具,对保持老年脑健康及提升生活质量具有重要意义.本文从脑结构老化、脑功能老化以及脑血流量与脑老化等方面概述了认知老化的神经机制.前人从补偿和去分化角度构建了多个认知老化理论和假说,然而,这些理论和假说较少考虑到脑结构老化、静息态研究及脑血流量的研究发现.坚持规律的运动、多做一些认知参与的活动、保持健康的生活方式和饮食模式,有助于老年人保持认知功能并延缓认知与脑老化.在老化认知神经科学未来发展方向上,从认知老化理论的发展以及成人毕生发展视角,对脑老化的脑功能网络研究、脑老化与可塑性以及基因对脑老化的影响等方面进行了展望.最后,本文从建立中国成人毕生发展行为-基因-脑数据库、使用和研发新技术研究认知老化、深入探索有效的脑功能改善方法、开展农村老年人研究及临床老年群体研究等方面,对国内老化认知神经科学的发展趋势进行了展望.     

实验性糖尿病心肌病大鼠模型建立及心脏功能和结构相关性分析

目的建立实验性糖尿病心肌病大鼠模型,观察心功能和结构变化,初步分析心脏功能和结构指标相关性。方法雄性Wistar大鼠随机分为正常对照组、高糖高脂膳食组和糖尿病心肌病模型组,采用高糖高脂膳食12周负荷一次性小剂量STZ腹腔注射建立糖尿病心肌病模型,观察各组动物心脏功能、心脏重量和心重指数、左心室形态和胶原含量等的变化。结果 (1)与正常对照组比较,糖尿病心肌病模型组大鼠左心室舒张末压(LVEDP)和最大舒张速率(-dp/dtmax)值显著升高(P0.05),心率(HR)、左心室收缩压(LVSP)、左心室最大收缩速率(+dp/dtmax)、每搏输出量(SV)和心排量(CO)明显降低(P0.05);全心重指数(HW/BW)和左心室重量指数(LVW/BW)明显升高(P0.01);常规HE染色显示心肌细胞排列紊乱,心肌细胞肥大,细胞核边缘不清等,室间隔和左心室壁厚度明显增加(P0.001,P0.05);心肌胶原含量明显增加(P0.05)。(2)大鼠心脏功能参数±dp/dtmax和CO值分别与结构参数HW/BW和LVW/BW呈现明显的相关性(P0.01或P0.05)。结论大鼠高糖高脂膳食喂养负荷小剂量STZ一次性腹腔注射,可造成心脏舒张和收缩功能紊乱以及心肌结构重塑,心脏功能与结构变化呈显著相关性,可复制实验性糖尿病心肌病模型。     

老年人中枢交感神经紧张性增加对心血管系统的影响

随着年龄的增加,中枢交感神经的紧张性增加,这会引起心血管系统的结构和功能有所改变,如四肢血流量减少、动脉血压调节发生改变、压力反射作用减弱、动脉管腔增厚以及心血管系统对肾上腺素受体的刺激反应性降低等。这些改变可能是在机体衰老过程中维持自身生理功能和机体稳态的重要代偿因素,同时也是促发老年人心血管疾病和代谢性疾病的危险因素。因此,研究老年人群交感神经的慢性紧张性增加对心血管系统的影响对进一步改善和提高老年人生活质量,治疗老年人疾病有着很大的意义。     

不同鼠龄的人多巴胺D5^F173L突变基因转基因高血压小鼠血压及心脏结构与功能分析

目的通过对不同年龄多巴胺D5^F173L突变基因及D5正常基因转基因小鼠的血压和心脏结构与功能进行分析,了解多巴胺D5受体在高血压发生发展过程中的作用。方法利用无创血压测量仪和高分辨率小动物超声系统检测两种转基因小鼠的血压和左心室壁厚度、左心室内径、左心室容积、射血分数、短轴缩短率和左心室质量等心脏功能指标。结果 D5^F173L转基因小鼠4月龄、6月龄、16月龄时收缩压、舒张压都明显高于D5转基因小鼠;4月龄、6月龄的D5F173L转基因小鼠与D5转基因小鼠相比舒张期和收缩期左室壁厚度均明显增大、左室内容积均明显变小、左心室重量增加;16月龄的D5^F173L转基因小鼠与D5转基因小鼠相比左心室前壁增厚、心腔内径缩短,心腔容积下降、心室重量增加、射血分数提高、短轴缩短率提高;在18月龄时D5^F173L转基因小鼠相比于D5转基因小鼠左心室收缩期前壁厚度增加,后壁厚度减少,舒张期前壁厚度增加,后壁厚度减少;另外在18月龄时D5^F173L转基因小鼠与其16月龄时相比,射血分数、短轴缩短率明显降低,收缩期左心室容积明显增大。结论 D5^F173L转基因小鼠的血压及心脏功能与结构的分析结果符合原发性高血压的特征。D5^F173L转基因小鼠可作为原发性高血压动物模型。     

异丙肾上腺素激发试验在大鼠酒精性心肌病模型评价中的应用

目的:建立大鼠酒精性心肌病模型,采用异丙肾上腺素激发试验评价模型大鼠心功能。方法:成年雄性SD大鼠以20 g/(kg.d)白酒(52°v/v)灌胃15 d。观察大鼠一般状况、心肌标本病理学及超微结构改变;通过左心室插管、异丙肾上腺素试验(IPT),测量大鼠在不同状态下的左心室内压、收缩压、舒张压、最大收缩速度、最大舒张速度。结果:模型组大鼠心脏舒缩功能降低,心力储备明显下降,心血管系统整体调节能力降低。病理见心肌细胞肥大、坏死,炎症细胞浸润;电镜见线粒体肿胀变形,嵴受损,肌原纤维断裂。结论:高度酒灌胃可使大鼠发生酒精性心肌病,该法稳定可靠。异丙肾上腺素试验(IPT)可准确考察心脏心力储备状况,显现潜在心功能减退。     

慢性肾脏病患者心脏结构与功能变化的超声心动图研究

目的:研究慢性肾脏病(CKD)患者心脏结构及功能的变化.方法:选择我院肾内科175例慢性肾脏病未透析患者,按照2003年美国国家肾脏基金会-肾脏病转归质量(NKF-K/DOQI)指南的标准进行分期,观察所有患者心脏结构及功能在超声中的变化.结果:慢性肾脏病患者随着肾功能的恶化,各组之间比较,室间隔厚度(IVST)、左心室后壁厚度(LVPW)、左心室心肌重量指数(LVMI)、左心室舒张末期内径(LVDd)、左心房内径(LAD)具有升高的趋势(P＜0.05,P＜0.01);但E/A比值未出现伴随着肾功能恶化而逐渐减低的趋势(P＞0.05);射血分数(EF)、短轴缩短卒(FS)在各期之间无明显变化(P＞0.05);而TVI技术测定的Em、Em/Am具有显著减低的趋势(P＜0.05,P＜0.01);瓣膜返流以二尖瓣返流为主.结论:慢性肾脏病患者心脏结构与功能随肾功能减退而加重,超声心动图检查结合组织速度显像(TVI)技术能更好地检测心脏结构和功能变化,尤其是检测左心室舒张功能障碍.     

心脏组织特异性表达 Neuregulin -2转基因小鼠的建立及心脏功能分析

目的：神经调节蛋白2（ neuregulin-2, NRG2）可促进神经系统发育,基因缺失表现早期生长延迟, NRG2在心脏中也有表达,但其在心脏发育尤其是病理刺激时对心脏结构及功能的影响尚未见报道。本文目的是建立心脏组织特异性表达NRG2转基因小鼠,分析其在正常及压力负荷刺激时对心脏结构及功能的影响。方法将人NRG2基因插入到心脏特异性启动子α-MHC下游,构建转基因表达载体,显微注射法建立NRG2转基因小鼠,PCR鉴定转基因小鼠基因型,western blot鉴定NRG2蛋白在心脏中的表达并筛选高表达的转基因品系,主动脉缩窄术（ transverse aortic constriction , TAC）制备压力负荷诱导的心肌肥厚小鼠模型。利用超声影像分析和病理学观察小鼠心脏结构和功能改变。结果建立了心脏组织特异性高表达NRG2转基因小鼠品系。与同窝阴性转基因小鼠相比,转基因小鼠左心室舒张末期后壁厚度（LVPWD）明显增加,3月龄时可达15．6％（P＜0．05）,经压力负荷刺激后,NRG2转基因手术小鼠心室壁增厚程度显著下降,心室腔增大,同时心肌排列紊乱程度和纤维化程度明显比NTG手术小鼠严重。结论在压力负荷下,转基因表达NRG2缩短了肥厚过程,同时加速了心衰进程。     

跑步训练诱导小鼠生理性心脏肥厚模型

目的用长期跑步训练诱导小鼠的生理性心脏肥厚模型,与主动脉缩窄手术诱导的病理性心脏肥厚模型进行比较。方法 8周龄野生型雄性C57BL/6小鼠分为跑步运动组,正常对照组,手术刺激组和假手术组。运动组跑步训练40d,手术刺激组行主动脉缩窄手术2周,从组织形态学、超声心动图、分子标志物表达等方面对模型进行全面评估。结果运动训练组小鼠心脏体重比与正常对照组相比增加27.2%(P<0.05),左心室体重比增加25.8%(P<0.01),心脏显著肥厚。超声心动图显示,与各自的对照组相比,运动组和手术组小鼠模型的左心室后壁厚度均显著增加(P<0.05),但运动组小鼠的相对室壁厚度无明显变化,而手术组小鼠相对室壁厚度显著增加50%(P<0.05),提示两种不同的心脏肥厚导致在心脏结构改变上差别显著。心脏肥厚分子标志物心房利钠肽和脑钠肽在手术组表达显著上调9.5倍和4.5倍,而在运动组下调为对照组的0.48倍和0.58倍,提示两种不同肥厚的分子机制差别迥异。结论长期跑步运动可以成功的诱导小鼠生理性心脏肥厚模型,其表型和分子机制与手术刺激的病理性肥厚差别显著。     

超声成像技术分析糜酶转基因小鼠心脏功能

目的 应用小动物高频超声技术对糜酶转基因小鼠的心功能进行分析,以探索糜酶基因对心脏结构和功能的影响。方法 通过VisualSonics Vevo770高分辨率小动物超声系统检测不同年龄的转基因小鼠及对照小鼠包括心壁厚度、主动脉血流速度、左心室内径、左心室容积、每搏输出量、射血分数、短轴缩短率和心输出量等的心脏功能指标的改变进行比较分析。结果 随着小鼠年龄的增大,转基因阳性小鼠心壁厚度和主动脉血流速度逐渐增加,至6月龄时,转基因小鼠的左心室前壁收缩期厚度增加37%,增长率是对照小鼠的1.2倍（P〈0.05）;主动脉血流速度比对照小鼠高29%（P〈0.05）;转基因阳性小鼠的左心室内径、左心室容积、每搏输出量、射血分数、短轴缩短率和心输出量等的心脏功能指标表现出和以上变化相一致的表型。结论 转基因小鼠糜酶表达水平升高,引起心脏AngⅡ形成增多,可使心肌细胞的收缩力提高;心肌细胞肥大,心壁增厚;且有随年龄增加的趋势,可研究建立慢性、老年性肥厚型心脏病模型。     

Concentric adaptation of the left ventricle in response to controlled upper body exercise training.

Upper body exercise has many applications to the rehabilitation and maintenance of cardiovascular health of individuals who are unable to exercise their lower body. The hemodynamic loads of upper body aerobic exercise are characterized by relatively high blood pressure and relatively low venous return. It is not clear how the left ventricle adapts to the specific hemodynamic loads associated with this form of exercise training. The purpose of this study was to measure left ventricular structure and function in previously sedentary men by using echocardiography before and after 12 wk of aerobic arm-crank exercise training (n = 22) or a time control period (n = 22). Arm-crank peak oxygen consumption (in ml x kg(-1) x min(-1)) increased by 16% (P < 0.05) after training, and significant differences (P < 0.05) were found in wall thickness (from 0.86 to 0.99 cm) but not in left ventricular internal dimension in diastole or systole. This suggested a concentric pattern of left ventricular hypertrophy that persisted after scaling to changes in anthropometric characteristics. No differences (P < 0.05) were found for any measurements of resting left ventricular function. We conclude that upper body aerobic exercise training results in a specific left ventricular adaptation that is characterized by increased left ventricular wall thickness but no change in chamber dimension.     

Evaluation of the cardiovascular function of older adult Rhesus monkeys by ultrasonography

OBJECTIVE: To evaluate the cardiovascular structure and function of older adult Rhesus monkey by utrasonography. METHODS: Sixteen monkeys aged from 17 to 20 years and weighing from 8.2 to 15.3 kg, six adults aged 7-8 years and weighing from 8.1 to 9.2 kg. All monkeys were determined to be free from hypertension, hyperglycaemia and cardiac disease. The normal values of index related to heart and blood vessels including structure, haemodynamics and systolic or diastolic function were detected by 2D, M-mode, pulsed Doppler and tissue Doppler echocardiography respectively under ketamine hydrochloride sedation. Meanwhile, blood pressures were also measured by electronic sphygmomanometer. Each monkey underwent repeated detections in 2 weeks and all data were analysed with statistical methods. RESULTS: Compared with young adult monkeys, the older's heart rate (HR), the left ventricular diastolic function and the compliance of big artery including right and left common carotid artery, bulbus caroticus, internal carotid artery and abdominal aorta were decreased and the associated indexes changed significantly (P < 0.05 or P < 0.01). Meanwhile, older monkeys exhibited significant increase in the aorta diameter (AO), amplitude of aortic wall (AAO), left atrial diameter (LAD), end diastolic volume of left ventricle (EDV), stroke volume (SV), left ventricular mass (LVM) (P < 0.05 vs. young adult monkeys); however, cardiac output (CO) only slightly increased but the difference did not reach the statistical significance (P = 0.418, P = 0.644 respectively). CONCLUSIONS: The present results demonstrated the profiles of cardiovascular function and structure in the older Rhesus monkeys. Older monkey is accompanied by diminished left ventricular diastolic function and big artery compliance. Ultrasonography provides a means to non-invasively evaluate the anatomy and function of the heart and blood vessel, and plays an increasingly important role in the drug evaluation against cardiovascular dysfunction.     

Aging and physical activity determine cardiac structure and function in the older athlete.

To evaluate the effects of age and physical activity on cardiac structure and function, 45 ultra-endurance athletes were compared with 24 sedentary control subjects. Two-dimensionally guided M-mode echocardiograms and pulsed Doppler studies of left ventricular inflow velocity were obtained. Both older and younger athletes differed from age-similar sedentary control subjects in having lower heart rates (56 vs. 72 beats/min, younger; 53 vs. 74 beats/min, older), larger left ventricular cavities at end diastole (5.4 vs. 4.9 cm younger; 5.4 vs. 4.9 cm older), and higher ratios of early to atrial inflow velocities (2.14 vs. 1.37, younger; 1.32 vs. 0.83, older; all P less than 0.05). Older athletes differed from younger athletes in having higher systolic and diastolic blood pressures (131/79 vs. 122/71 mmHg), greater posterior wall thickness (1.1 vs. 0.9 cm), lower rapid filling velocity (52 vs. 70 cm/s), higher atrial systolic velocity (41 vs. 34 cm/s), and lower early-to-atrial inflow velocity ratios (1.32 vs. 2.14, all P less than 0.05). Thus the aging heart manifests structural and functional changes in response to physical activity that are similar but not identical to those seen in younger subjects. The expected pattern of cardiac alterations normally seen in response to age is modified in the older athlete, suggesting that exercise training, as well as aging, is an effective stimulus in shaping left ventricular structure and function in the older heart.     

Impaired ventricular filling limits cardiac reserve during submaximal exercise in people with type 2 diabetes

Background

Attenuated increases in ventricular stroke volume during exercise are common in type 2 diabetes and contribute to reduced aerobic capacity. The purpose of this study was to determine whether impaired ventricular filling or reduced systolic ejection were responsible for the attenuated stroke volume reserve in people with uncomplicated type 2 diabetes.

Methods

Peak aerobic capacity and total blood volume were measured in 17 people with diabetes and 16 non-diabetic controls with no evidence of cardiovascular disease. Left ventricular volumes and other systolic and diastolic functional parameters were measured with echocardiography at rest and during semi-recumbent cycle ergometry at 40 and 60% of maximal aerobic power and compared between groups.

Results

People with diabetes had reduced peak aerobic capacity and heart rate reserve, and worked at lower workloads than non-diabetic controls. Cardiac output, stroke volume and ejection fraction were not different at rest, but increased less in people with diabetes during exercise. Left ventricular end systolic volume was not different between groups in any condition but end diastolic volume, although not different at rest, was smaller in people with diabetes during exercise. Total blood volume was not different between the groups, and was only moderately associated with left ventricular volumes.

Conclusions

People with type 2 diabetes exhibit an attenuated increase in stroke volume during exercise attributed to an inability to maintain/increase left ventricular filling volumes at higher heart rates. This study is the first to determine the role of filling in the blunted cardiac reserve in adults with type 2 diabetes.

     

Cardiovascular adaptations to exercise training in the elderly

Maximal O2 uptake (VO2max) and left ventricular function decrease with age. Endurance exercise training of sufficient intensity, frequency, and duration increases VO2max in the elderly. The mechanisms underlying the increased VO2max in the elderly are enhanced O2 extraction of trained muscle during maximal exercise leading to a wider arteriovenous O2 difference, and higher cardiac output in the trained state. However, increased cardiac output during true maximal exercise has not been documented in elderly subjects. Endurance exercise training results in a lower heart rate and rate pressure product during submaximal exercise at a given intensity. However, no improvement in left ventricular function has been reported in the elderly after exercise training. Highly trained master athletes exhibit proportional increases in the left ventricular end-diastolic dimension and wall thickness suggestive of volume-overload hypertrophy compared with age-matched sedentary controls. The magnitude of left ventricular enlargement is similar to that in young athletes. The failure of exercise training to alter the age-related deterioration of left ventricular function in the elderly may reflect an insufficient training stimulus rather than the inability of the heart to adapt to training in elderly subjects.     

Interrelationships between left ventricular volume and output during exercise in healthy subjects.

To better characterize the relationship between left ventricular volume response and improved ventricular ejection and output during supine exercise in normal subjects, 36 healthy asymptomatic volunteers (age 39 +/- 17 yr) were studied with radionuclide ventriculography during recumbent bicycle ergometry. Relative changes in left ventricular end-diastolic and end-systolic volume were measured at rest and during exercise by a modification of the radionuclide counts-based method that accounted for variability in stress blood pool counts. A biphasic response was noted in left ventricular end-diastolic volume with an initial increase in early exercise (8.5 +/- 11% at 200 kpm/min and 11 +/- 12% at 300 kpm/min) followed by a progressive and significant decline at peak exercise (-3.3 +/- 18% at 547 +/- 140 kpm/min; P < 0.05). There was substantial variation in end-diastolic volume response at peak exercise in the group as a whole, which could be more closely related to changes in end-systolic volume (r = 0.84, P < 0.0001) than in heart rate (r = -0.57, P < 0.01) or age (r = 0.36, P < 0.05) of the study subjects. Despite the decline in ventricular filling, systolic function appeared to improve dramatically at peak exercise (change in left ventricular ejection fraction 15.5 +/- 6.4, P < 0.0001). Although not directly related to increasing systolic ejection, end-diastolic volume was directly related to the percent change in stroke volume at peak exercise among the study subjects (r = 0.88, P < 0.0001).(ABSTRACT TRUNCATED AT 250 WORDS)     

The left ventricle and hemodynamic patterns in essential hypertension

Hemodynamic patterns in hypertensive patients by radionuclide techniques and tomographic gamma camera were evaluated. In younger hypertensive patients, the hyperkinetic state reflected an increase in heart rate and, consequently, an increased cardiac index and left ventricular ejection fraction (LVEF). Older hypertensive patients, however, showed a different hemodynamic pattern, with reduced systolic and diastolic function at rest compared with normotensive elderly people, and marked depression of cardiac systolic and diastolic reserve during exercise. They also showed strikingly higher hyperresistance and reduced peripheral perfusion. These hemodynamic differences need to be taken into account when considering antihypertensive treatment. In a study in 106 elderly hypertensive patients, treatment with four different antihypertensive drugs produced a significant decrease in total peripheral resistance and blood pressure, together with a reduction in left ventricular (LV) afterload and an increase in cardiac output and LVEF (tending towards normal values). The LV peak filling rate was also increased and evaluation of systolic and diastolic cardiac reserve during exercise showed positive changes in cardiac performance. Left ventricular hyperthropy (LVH) is a powerful predictor of cardiac events. Long-term increases in BP predispose to LVH, impaired diastolic relaxation and, ultimately, ventricular dysfunction. A reduction in LVH produces a number of different beneficial effects. Coronary flow reserve was evaluated in hypertensive patients. Coronary flow reserve was highly impaired in comparison with normotensive controls, and increases in arteriolar wall thickness, collagen content and diastolic dysfunction were also noted. A marked improvement in coronary flow reserve in patients who received antihypertensive therapy was confirmed.     

Ventricular function during exercise in mice and rats

The mouse has many advantages over other experimental models for the molecular investigation of left ventricular (LV) function. Accordingly, there is a keen interest in, as well as an intense need for, a conscious, chronically instrumented, freely moving mouse model for the determination of cardiac function. To address this need, we used a telemetry device for repeated measurements of LV function in conscious mice at rest and during exercise. For reference, we compared the responses in mice to the responses in identically instrumented conscious rats. The transmitter body of the telemetry device (rat PA-C40; mouse PA-C10; Data Sciences International, St. Paul, MN) was placed in the intraperitoneal space through a ventral abdominal approach (rat) or subcutaneously on the left flank (mouse). The pressure sensor, located within the tip of a catheter, was inserted into the left ventricle through an apical stab wound (18 gauge for rat; 21 gauge for mouse) for continuous, nontethered, recordings of pulsatile LV pressure. A minimum of 1 wk was allowed for recovery and for the animals to regain their presurgical weight. During the recovery period, the animals were handled, weighed, and acclimatized to the laboratory, treadmill, and investigators. Subsequently, LV parameters were recorded at rest and during a graded exercise test. The results document, for the first time, serial assessment of ventricular function during exercise in conscious mice and rats. This methodology may be adopted for advancing the concepts and ideas that drive cardiovascular research.     

Cascade model of ventricular-arterial coupling and arterial-cardiac baroreflex function for cardiovascular variability in humans

Cardiovascular variability reflects autonomic regulation of blood pressure (BP) and heart rate (HR). However, systolic BP (SBP) variability also may be induced by fluctuations in stroke volume through left ventricular end-diastolic pressure (LVEDP) variability via dynamic ventricular-arterial coupling during respiration. We hypothesized that dynamic ventricular-arterial coupling is modulated by changes in left ventricular compliance associated with altered preload and that a cascade control mechanism of ventricular-arterial coupling with arterial-cardiac baroreflex function contributes to the genesis of cardiovascular variability at the respiratory frequency. Seven healthy young subjects underwent 6-min recordings of beat-by-beat LVEDP, SBP, and HR in the supine position with controlled respiration at 0.2 Hz during hyper- and hypovolemia. Spectral and transfer function analysis of these variables was conducted between 0.18 and 0.22 Hz. Dynamic ventricular-arterial coupling gain (Gain LVEDP-SBP) was smaller by 25% (P = 0.009) during hypervolemia than during hypovolemia, whereas arterial-cardiac baroreflex function gain (Gain SBP-HR) was similar. As predicted from a cascade model, a linear relationship between Gain LVEDP-HR and LVEDP-SBP times Gain SBP-HR was identified (R(2) = 0.93, P < 0.001). Gain LVEDP-HR was smaller by 40% (P = 0.04) during hypervolemia than during hypovolemia, leading to a reduction in spectral power of HR variability by 45% (P = 0.08). We conclude that dynamic ventricular-arterial coupling gain is reduced during hypervolemia because of a decrease in left ventricular compliance. A cascade model of ventricular-arterial coupling with the arterial-cardiac baroreflex contributes to the genesis of cardiovascular variability at the respiratory frequency.