Aging and Diastolic Dysfunction: The Interplay of Inflammation and Extracellular Matrix Regulation

  • Peter Moritz Becher
  • Dirk Westermann
  • Carsten Tschöpe
Chapter

Abstract

Fifty percent of all heart failure patients have a preserved ejection fraction. The majority of patients with this syndrome are older than patients with heart failure and reduced ejection fraction (EF) and are more often females. Patients with heart failure with preserved ejection fraction (HFPEF) have an increased mortality and morbidity rate and have been found to be similar compared with patients with heart failure and reduced EF. One of the underlying mechanisms leading to the clinical symptomatology in patients with HFPEF is diastolic dysfunction characterized by an increased diastolic stiffness. Additional non-diastolic function abnormalities with exercise-induced changes in systolic velocity, chronotropic incompetence, and ventricular–vascular uncoupling have also been demonstrated to contribute to this syndrome. The accumulation of cardiac collagen was shown to be present in this disease and to contribute to the aggravation of diastolic dysfunction. Moreover, an enhanced endothelial migration of inflammatory cells into the myocardium might influence the development of these changes, especially in regard to changes in the extracellular matrix (ECM). It was also shown that secreted protein acidic and rich in cysteine (SPARC) plays a key role in the changes in post-synthetic procollagen processing that occur especially in the aged myocardium. Oxidative stress and inflammation are important triggers of myocardial fibrosis, and therefore it plays a significant role in older patients with HFPEF. The induction of this process is unclear and may include age-dependent and comorbidity-dependent mechanisms.

Keywords

Diastolic Dysfunction Heart Failure With Preserve Ejection Fraction Transverse Aortic Constriction Heart Failure With Reduce Ejection Fraction Cardiac Inflammation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Abbreviations

CVF

Collagen volume fraction

ECM

Extracellular matrix

HFNEF

Heart failure with normal ejection fraction

HFPEF

Heart failure with preserved ejection fraction

HFREF

Heart failure with reduced ejection fraction

HHD

Hypertensive heart disease

LOX

Lysyl oxidase

LV

Left ventricular

LVMI

Left ventricular mass index

MMP

Matrix metalloproteinase

RV

Right ventricular

TIMP

Tissue inhibitor of metalloproteinases

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Peter Moritz Becher
    • 1
  • Dirk Westermann
    • 1
  • Carsten Tschöpe
    • 2
  1. 1.Department of General and Interventional CardiologyUniversity Heart Center Hamburg EppendorfHamburgGermany
  2. 2.Department of Cardiology and AngiologyCharité-Universitätsmedizin BerlinBerlinGermany

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