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Biomedical subjects

G de Simone

Publications and source records attributed to G de Simone.

At least 19 recordsLinked to original sources
PubMed2001

Effects of once-daily angiotensin-converting enzyme inhibition and calcium channel blockade-based antihypertensive treatment regimens on left ventricular hypertrophy and diastolic filling in hypertension: the prospective randomized enalapril study evaluating regression of ventricular enlargement (preserve) trial.

BACKGROUND: The Prospective Randomized Enalapril Study Evaluating Regression of Ventricular Enlargement (PRESERVE) study was designed to test whether enalapril achieves greater left ventricular (LV) mass reduction than does a nifedipine gastrointestinal treatment system by a prognostically meaningful degree on a population basis (10 g/m(2)). METHODS AND RESULTS: An ethnically diverse population of 303 men and women with essential hypertension and increased LV mass at screening echocardiography were enrolled at clinical centers on 4 continents and studied by echocardiography at baseline and after 6- and 12-month randomized therapy. Clinical examination and blinded echocardiogram readings 48 weeks after study entry in an intention-to-treat analysis of 113 enalapril-treated and 122 nifedipine-treated patients revealed similar reductions in systolic/diastolic pressure (-22/12 versus -21/13 mm Hg) and LV mass index (-15 versus -17g/m(2), both P>0.20). No significant between-treatment difference was detected in population subsets defined by monotherapy treatment, sex, age, race, or severity of baseline hypertrophy. Similarly, there was no between-treatment difference in change in velocities of early diastolic or atrial phase transmitral blood flow. More enalapril-treated than nifedipine-treated patients required supplemental treatment with hydrochlorothiazide (59% versus 34%, P<0.001) but not atenolol (27% versus 22%, NS). CONCLUSIONS: Once-daily antihypertensive treatment with enalapril or long-acting nifedipine, plus adjunctive hydrochlorothiazide and atenolol when needed to control blood pressure, both had moderately beneficial and statistically indistinguishable effects on regression of LV hypertrophy.

Adult↗
PubMed2001

Relations of stroke volume and cardiac output to body composition: the strong heart study.

BACKGROUND: Although cardiac output (CO) plays the vital role of delivering nutrients to body tissues, few data are available concerning the relations of stroke volume (SV) and CO to body composition in large population samples. METHODS AND RESULTS: Doppler and 2D echocardiography and bioelectric impedance in 2744 Strong Heart Study participants were used to calculate SV and CO and to relate them to fat-free body mass (FFM), adipose mass, and demographic variables. Both SV and CO were higher in men than women and in overweight than normal-weight individuals, but these differences were diminished or even reversed by normalization for FFM or body surface area. In both sexes, SV and CO were more strongly related to FFM than adipose mass, other body habitus measures, arterial pressure, diabetes, or age. In multivariate analyses using the average of Doppler and left ventricular SV to minimize measurement variability, FFM was the strongest correlate of SV and CO; other independent correlates were adipose mass, systolic pressure, diabetes, age, and use of digoxin and calcium channel and beta-blockers. CONCLUSIONS: In a population-based sample, SV and CO are more strongly related to FFM than other variables; increased FFM may be the primary determinant of increased SV and CO in obesity.

Adipose Tissue↗
PubMed2001

Inappropriate left ventricular mass in normotensive and hypertensive patients.

We evaluated cardiovascular features of normotensive and hypertensive adults with left ventricular (LV) mass values exceeding levels predicted for given stroke work, gender, and height, termed "inappropriate" LV mass. Inappropriate LV mass is associated with overweight, concentric LV geometry, and low myocardial systolic function not only in hypertensive subjects, but also in normotensive subjects.

Adult↗
PubMed2001

Left ventricular function and hemodynamic features of inappropriate left ventricular hypertrophy in patients with systemic hypertension: the LIFE study.

BACKGROUND: Predicted left ventricular (LV) mass for sex, height (2.7), and hemodynamic load can be used as an intrapatient reference for the observed LV mass. The ratio of observed/predicted LV mass may allow more physiologically correct comparisons of LV geometry, systolic and diastolic functions, and hemodynamics among hypertensive patients. METHODS: We studied 659 participants in the LIFE (Losartan Intervention for Endpoint Reduction in Hypertension) study with both electrocardiographic and echocardiographic LV hypertrophy (68% of the echocardiographic cohort) without previous myocardial infarction. LV mass was predicted by an equation including sex, stroke work, and height (2.7). Observed/predicted LV mass > 128% defined inappropriate LV hypertrophy (iLVH). Relative wall thickness > or = 0.43 defined concentric LV geometry. Systolic myocardial dysfunction was assessed by midwall mechanics and abnormal LV relaxation by isovolumic relaxation time (IVRT). RESULTS: Compared with patients with appropriate LV hypertrophy (aLVH), those with iLVH had higher body mass index, LV mass index, relative wall thickness, prevalences of systolic myocardial dysfunction and prolonged IVRT and lower end-systolic stress and cardiac index. Patients with eccentric iLVH had the highest wall stress and lowest ejection fraction; 43% had systolic myocardial dysfunction. Of patients with concentric iLVH, 79% had systolic myocardial dysfunction but normal ejection fraction and the lowest wall stress. Systolic myocardial dysfunction was present in 12% with concentric aLVH and none with eccentric aLVH. Prevalence of prolonged IVRT was high in all 4 groups (65% to 77%). Cardiac index was similarly lower with concentric or eccentric iLVH than with aLVH. CONCLUSIONS: Among hypertensives with LV hypertrophy, iLVH identified cardiac phenotypes with a high prevalence of myocardial systolic dysfunction.

Aged↗
PubMed2001

Prognostic implications of the compensatory nature of left ventricular mass in arterial hypertension.

OBJECTIVE: To test whether inappropriate echocardiographic left ventricular (LV) mass (i.e. higher than predicted by individual body size, sex and cardiac load [delta%LVM]) is associated with an increased rate of cardiovascular events, and whether values of LV mass lower than appropriate confer protection. DESIGN: Prospective, longitudinal. SETTING: Institutional, hospital outpatient clinic. PATIENTS: A total of 294 hypertensive patients, 84 with inappropriate and 21 with low LV mass (lower than appropriate). MAIN OUTCOME MEASURES: Cardiovascular fatal and non-fatal events. RESULTS: Baseline delta%LVM was higher in patients with follow-up total (n = 50) or fatal (n = 14) events than in event-free survivors (all P < 0.0001) and predicted events independently of age and systolic pressure (all P < 0.0001). Although the performance was not better than with use of more traditional definition of LV hypertrophy, delta%LVM remained a predictor even in the subgroup of 126 patients (32 total events, 13 deaths) with clear-cut LV hypertrophy (P < 0.009). Patients with low LV mass exhibited supranormal LV chamber and midwall function, slightly higher heart rate and higher cardiac index (all P< 0.01). These patients had the same rate of events as those with appropriate LV mass. CONCLUSIONS: In hypertensive patients, increase in LV mass beyond values required to compensate cardiac workload at a given body size and sex predicts cardiovascular risk independently of age and blood pressure, in the whole population as well as in the subset of patients with LV hypertrophy. Hypertensive patients with levels of LV mass lower than needed to compensate cardiac workload exhibit hyperdynamic circulatory status and the same risk pattern as patients with higher values of LV mass, possibly due to activation of the sympathetic system.

Blood Pressure↗
PubMed2001

Appropriate or inappropriate left ventricular mass in the presence or absence of prognostically adverse left ventricular hypertrophy.

OBJECTIVES: To evaluate whether assessment of appropriateness of left ventricular mass (LVM) adds to the traditional definition of left ventricular hypertrophy (LVH). DESIGN: Cross-sectional, relational. METHODS: Echocardiographic LVH and appropriateness of LVM were studied in 562 subjects (231 normotensive controls, aged 35+/-11 years, 142 women; 331 hypertensive patients, aged 47+/-11 years, 135 women) classified on the basis of either the presence or the absence of both LVH (LVM index > or = 51 g/m2.7) and inappropriate LVM (LVM > 128% of the value predicted by an equation including age, sex and stroke work). RESULTS: Body mass index was comparable in hypertensive patients and controls. Hypertensive patients without LVH but with inappropriate LVM (n = 21) had higher relative wall thickness and total peripheral resistance than all other groups, whereas cardiac output was lower (all P < 0.001). Midwall mechanics was normal with appropriate LVM, independently of presence of LVH, whereas it was depressed in inappropriate LVM, either with or without LVH (both P < 0.0001). There was no substantial difference in ejection fraction among controls and hypertensive groups. Stress-corrected midwall shortening was more closely related to deviation of LVM from the value appropriate for stroke work, body size and gender (r = -0.56, P < 0.0001) than to LVM index (r = -0.26). CONCLUSIONS: Inappropriate LVM is associated with concentric geometry, high peripheral resistance and depressed wall mechanics. The deviation of LVM from the value appropriate for stroke work, body size and sex correlates with measures of myocardial function better than LVM.

Adolescent↗
PubMed2001

Relation of hemodynamics and risk factors to ventricular-vascular interactions in the elderly: the Cardiovascular Health Study.

OBJECTIVE: To investigate the interaction between left ventricular (LV) geometry, carotid structure and arterial compliance in relation to hemodynamic stimuli and risk factors (plasma cholesterol, body mass index, insulin resistance, smoking habit, age, sex and race). DESIGN: Cross-sectional. METHODS: Echocardiography and carotid ultrasound were performed in 2375 elderly subjects without signs or history of prevalent cardiovascular disease, diabetes or renal disease (795 men; 298 non-whites; 1215 hypertensive), from the cohort of the Cardiovascular Health Study. Arterial compliance was estimated by the prognostically validated ratio of stroke volume to pulse pressure (SV/PP) as the percent deviation (Delta%) from the value predicted by individual age, heart rate and body weight. RESULTS: Intima-medial thickness (IMT) was higher in the presence of LV hypertrophy (LVH) in normotensive and hypertensive subjects and was greatest in the presence of concentric LVH. Maximum carotid lumen diameter (CLD) was also higher in the presence of LVH (and was greatest with eccentric LVH, in association with relatively high values for stroke volume). After adjusting for blood pressure, maximum carotid lumen diameter was directly correlated with stroke volume, and IMT to LV mass (all P < 0.001). Similarly, IMT was also related to maximum carotid lumen diameter, independently of prevalent risk factors (P < 0.001). SV/PP-Delta% was reduced in both groups with concentric LV remodeling (both P < 0.0001) or concentric LVH (both P < 0.05). Adjusting for risk factors did not affect these associations in normotensives, but made them insignificant in hypertensives. In normotensives, IMT was inversely related to SV/PP-Delta% (P < 0.001), independently of risk factors, whereas no significant relation was found in hypertensives. CONCLUSIONS: The magnitudes of carotid intima-medial thickness and lumen diameter parallel levels of LV mass and geometry, and are directly related to stroke volume and arterial stiffness; this interaction is most evident in the presence of normal blood pressure, whereas it is affected by other cardiovascular risk factors when arterial hypertension is present.

Aged↗
PubMed2001

Relation of age to left ventricular function and systemic hemodynamics in uncomplicated mild hypertension.

Previous studies in normotensive subjects have shown a slight decline in resting left ventricular pump function and midwall contractility with aging. We examined the relations of age to these variables and to peripheral resistance and vascular stiffness in 272 asymptomatic, unmedicated adults (25 to 80 years old) who had uncomplicated essential hypertension. Cardiac and carotid ultrasound and carotid pressure waveforms were obtained to measure left ventricular dimensions, endocardial and midwall left ventricular shortening, stroke index and cardiac index, end-systolic stress, and pulse pressure/stroke index and beta, pressure-dependent and independent measures of vascular stiffness, respectively. Endocardial and midwall stress-corrected left ventricular shortening assessed ventricular performance. Cardiac index and TPRI did not change with age in either gender, with age-related increases in systolic pressure offset by increasingly concentric ventricular geometry in women and enhanced ventricular systolic function in men. In contrast to the lack of age-related change in traditional hemodynamic indexes, pulse pressure/stroke volume and beta strongly increased with age (P<0.001). Thus, in uncomplicated, relatively mild essential hypertension, neither cardiac index nor peripheral resistance is associated with age. This hemodynamic stability is associated with age-related increased concentricity of ventricular geometry in women and increased ventricular performance indexes in hypertensive men. Vascular stiffness progressively increases with age, independent of change in mean pressure or resistance, possibly contributing to increased rates of cardiovascular events in older individuals.

Adult↗
PubMed2001

Link of nonhemodynamic factors to hemodynamic determinants of left ventricular hypertrophy.

Despite current evidence suggesting that hemodynamic load is the fundamental stimulus to begin the sequence of biological events leading to the development of left ventricular hypertrophy, genotype, gender, body size, and less easily recognizable environmental factors may contribute to generate the cascade of molecular changes that eventually yield the increase in protein synthesis needed to increase left ventricular mass. However, even nonhemodynamic factors such as gender and body size eventually regulate the growth of left ventricular mass by at least in part influencing loading conditions. Consideration of measurable factors, such as gender, body size, and hemodynamic load, allows evaluation of individual echocardiographic left ventricular mass as the deviation from the level that would be required to face a gender-specific hemodynamic load at a given body size. Values of left ventricular mass that are inappropriately high for individual gender, body size, and hemodynamic load are associated with a high cardiovascular risk phenotype, even independent of the presence of arterial hypertension. Thus, the condition of inappropriately high left ventricular mass may be recognized as a more advanced stage of pathological structural changes initially induced by overload, going beyond the compensatory needs. The biological process that yields inappropriate left ventricular mass is probably linked to the protracted activity over time of biological mediators of left ventricular hypertrophy, such as proto-oncogenes and other growth factors, neurohormones, and cytokines, inducing structural modifications that initially compensate imposed overload but eventually change the structure of myocardial tissue and the composition of motor units.

Blood Pressure↗
PubMed2001

Original articles prognostic value of combined echocardiography and ambulatory blood pressure monitoring in hypertensive patients at low or medium cardiovascular risk.

BACKGROUND: The clinical value of echocardiography and ambulatory blood pressure monitoring (ABPM) in hypertensive patients at low immediate risk of cardiovascular disease is still unknown. METHODS: Echocardiography and ABPM were performed in 715 untreated subjects with essential hypertension World Health Organization/International Society of Hypertension stage I or II and low or medium cardiovascular risk defined by the absence of diabetes, previous cardiovascular events, left ventricular (LV) hypertrophy at electrocardiography, proteinuria, stages III-IV retinopathy and creatinine levels > 106.08 mmoll (1.2 mg/dl) and the presence of one or two traditional risk factors. RESULTS: The LV mass was increased in 26.5% of these subjects. Subjects with a limited blood pressure reduction from day to night (non-dippers) were 11.3%. Over 1-13 years of follow-up, 31 subjects developed a first major cardiovascular event. The event rate (per 100 person-years) was 0.60 in the subgroup with a normal LV mass vs 1.63 in that with an increased LV mass (p < 0.017), and 0.74 in dippers vs 3.75 in non-dippers (p < 0.001). On multivariate analysis, the relative risk of cardiovascular events was 1.70 (95% confidence interval-CI 1.23-2.36) for each 11 g/m(2.7) increment in LV mass (p < 0.01), and 2.77 (95% CI 1.12-6.83) in non-dippers vs dippers (p < 0.05). Overall, on the basis of results of combined echocardiography and ABPM, 33% of subjects were at increased risk of future cardiovascular events. CONCLUSIONS: At standard first-line work-up performed on hypertensive subjects at low or medium cardiovascular risk, combined echocardiography and ABPM identify an increase in the risk of subsequent cardiovascular disease in one third of subjects.

Blood Pressure↗
PubMed2001

Characterization of post-discharge atrial fibrillation following open-heart surgery in uncomplicated patients referred to an early rehabilitation program.

BACKGROUND: Atrial fibrillation (AF) is frequently observed after open-heart surgery, following discharge from the cardiac surgery clinic. Compared to those usually reported in the early postoperative period, this arrhythmia is delayed in onset and is often a cause of re-hospitalization. Post-discharge AF has never been characterized in the literature. METHODS: We retrospectively analyzed post-discharge AF occurring within 30 days of coronary artery bypass graft or of valvular procedures in 376 patients referred to an early postoperative rehabilitation program. To investigate the probability of the persistence of post-discharge AF, we prospectively examined 232 patients who had undergone valvular procedures. RESULTS: An arrhythmia was recognized in 61/376 patients (16%), resulted in worsening of the NYHA functional class in 27 (44%) and in life-threatening hemodynamic effects requiring urgent cardioversion in 5 (8%). Events were predicted by the occurrence of postoperative AF (6-fold higher risk), left ventricular hypertrophy, an enlarged left atrium and valvular pathology (3-fold) and by the lack of beta-blocker protection (5-fold). AF persisted in 20/232 (9% of the study population, 18% of patients who had post-discharge AF) and had a relevant impact on the patient's clinical status. Predictors of events were older age, an enlarged left atrium and a lower left ventricular ejection fraction. CONCLUSIONS: Post-discharge AF following open-heart surgery is frequent in patients undergoing valvular procedures and often persists over time. The clinical impact of the arrhythmia is relevant, it might cause re-hospitalizations in many circumstances and, consequently, may have an impact on hospital resources. Events are much less frequent in patients taking beta-blockers than in those who do not, and they can be predicted by simple variables observed in the early stages after surgery.

Adrenergic beta-Antagonists↗
PubMed2001

Relation of heart rate to left ventricular dimensions in normotensive, normal-weight children, adolescents and adults.

BACKGROUND: The quantitative relation between body growth and changes in heart rate, and the relationship of heart rate to left ventricular (LV) dimensions, independent of the influence of body size, have been only marginally investigated. Accordingly, we designed this study to investigate the relation between heart rate, body size and LV dimensions in children, adolescents and adults over a broad age span. METHODS: Eight hundred and nineteen normotensive, multi-racial, normal-weight individuals (444 males, 375 females, aged 1-85 years) with normal LV systolic function were studied at echocardiography in three centers, using previously reported methods. The resting heart rate was measured on the M-mode echo-tracing or right after the echocardiogram with the subject still in the supine position. RESULTS: In children and adolescents (up to 17 years), the heart rate decreased with increasing body height (r = -0.51, p < 0.0001) and body weight (r = -0.42, p < 0.0001), in a similar manner in girls and boys. In adults, the heart rate was higher in women than in men, but it was not independently related to body size. The LV diastolic diameter was higher in males and decreased with increasing heart rate in children and adolescents (r = -0.45) as well as in adults (r = -0.25, both p < 0.0001). This relation was also independent of the effect of body size, sex and race. Similarly, the LV mass increased with decreasing heart rate in children and adolescents (r = -0.45), but the association was not confirmed after controlling for body size, sex and race. In adults, heart rate was inversely related to LV mass (r = -0.21, p < 0.0001), and this relation was also independent of body size, sex, race, age and blood pressure (p < 0.001). In women, the relation of heart rate to LV mass/height2.7 was less close than in men, due to the greater increase in LV mass with age. CONCLUSIONS: The heart rate has an inverse association with the LV chamber diameter and with the LV mass in children-adolescents and in adults. This relation is largely, but not uniquely, mediated by body proportions, especially during body growth.

Adolescent↗
PubMed2000

Relation of left ventricular diastolic properties to systolic function in arterial hypertension.

BACKGROUND: It is unclear whether impairment of left ventricular (LV) diastolic characteristics is independent of systolic dysfunction. METHODS AND RESULTS: To address this issue, 159 consecutive hypertensive patients (44+/-11 years, 78 obese, 96 women) and 165 normotensive subjects (32+/-11 years, 84 obese, 110 women) were studied with the use of Doppler echocardiography. After adjustment for age, body mass index (BMI), and sex, we found that ejection fraction (EF; M-mode, z-derived) was higher in hypertensive (66. 6+/-5.2%) than in normotensive (63.9+/-4.4%, P<0.0001) subjects, whereas midwall shortening (MS) was lower (hypertensive patients 16. 9+/-2.0%, normotensive subjects 17.8+/-2.2%, P<0.02), even after correction for end-systolic wall stress (P<0.05). Isovolumic relaxation time (IVRT) was greater in hypertensive patients (103+/-14 ms) than in normotensive subjects (78+/-19 ms), as was deceleration time of E velocity and peak A velocity (all P<0.0001). In multivariate analysis, IVRT was unrelated to EF, but a negative relation was found with MS (P<0.001), independent of age, BMI, presence of arterial hypertension, LV geometry, and load (multiple R(2)=0.58). For comparable age, sex distribution, BMI, and blood pressure values, hypertensive patients with lower afterload-adjusted MS exhibited longer IVRT than patients with normal MS (P<0.005). However, IVRT remained higher than in normotensive control subjects after control for LV geometry and load. CONCLUSIONS: Doppler indices of delayed LV relaxation can be detected in the presence of normal or supranormal EF but are independently related to impaired MS. A less severely abnormal relaxation, however, can be also detected in the presence of normal midwall function, independent of LV geometry and load. Thus, diastolic abnormalities may occur before systolic dysfunction even when it is measured at the midwall.

Adult↗
PubMed2000

Should all patients with hypertension have echocardiography?

The feasibility of echocardiographic determination of left ventricular (LV) mass, as well as the advantages that might be gained in some clinical circumstances and possible indications are examined in the present review, in relation to the recent WHO/ISH. The information obtained with echocardiograms in arterial hypertension is an important contribution to risk stratification on an epidemiological scale. In clinical practice, under the ascertained condition of a good reliability, an echocardiogram should be recommended as part of the initial work up when patients meet criteria for not starting therapy (low or mild risk WHO-ISH) or in all circumstances in which decision-making might be affected by the echocardiographic result. At present, there is not sufficient evidence to extend the indication of echocardiography also to patients for whom antihypertensive management is already necessitated by identification of high or very high risk status.

Echocardiography↗
PubMed2000

Pulmonary venous flow and mitral inflow velocity pattern in uncomplicated obesity: evidence for late diastolic dysfunction.

BACKGROUND: Active left ventricular relaxation, assessed by Doppler isovolumic relaxation time, is impaired in obesity. There is little information on left ventricular passive properties during filling. METHODS: To evaluate left ventricular late diastolic stiffness in obesity, Doppler echocardiographic interrogation of mitral inflow tract and pulmonary vein flow velocities were obtained from 47 normotensive, young obese subjects (11 males, 36 females) and 43 normotensive, young normal-weight volunteers (13 males, 30 females) of comparable age. RESULTS: After controlling the effect of blood pressure and left ventricular mass, isovolumic relaxation time was prolonged in obese subjects (p < 0.0001 vs normal-weight controls). No difference was found in transmitral peak early and late flow velocities. Obese subjects exhibited prolonged pulmonary vein reverse flow velocity during atrial contraction (p < 0.004), and a higher difference or ratio between duration of pulmonary reverse flow and duration of transmitral forward late flow (6 +/- 31 vs -20 +/- 39 ms or 1.06 +/- 0.3 vs 0.84 +/- 0.3, p < 0.002 and p < 0.001, respectively). These differences were also confirmed after controlling blood pressure and left ventricular mass. Non-invasively estimated left ventricular end-diastolic pressure was higher in obese subjects than in controls (p < 0.002). At multivariate analysis a higher body mass index was the sole predictor of prolonged difference between duration of pulmonary reverse flow and duration of transmitral forward late flow (beta = 0.38, p < 0.001). CONCLUSIONS: Obesity is associated with prolonged left ventricular active relaxation and abnormalities of filling pressure not detectable by the sole mitral inflow velocity pattern. These latter abnormalities are consistent with the presence of early increased left ventricular passive stiffness.

Adult↗
PubMed2000

Relation of left ventricular chamber and midwall function to age in normal children, adolescents and adults.

BACKGROUND: The goal of this study was to identify the effect of body growth and aging, and normal limits of the relation of left ventricular endocardial and midwall shortening to wall stress. METHODS: Endocardial and midwall shortening and circumferential end-systolic stress were assessed in 388 normotensive, normal-weight adults (226 men, 162 women, age 18 to 85 years) and 332 children and adolescents (180 males, 152 females, age 4 to 17 years) by two-dimensional targeted M-mode echocardiography and cuff blood pressure measurements. RESULTS: End-systolic stress decreased with age in children and adolescents (p < 0.001), but not during adulthood and maturity. The negative relation of endocardial shortening to end-systolic stress was stronger in adults than in children and adolescents (slope difference p < 0.005). The negative relation of midwall shortening to end-systolic stress was negligible in children and adolescents (r = -0.07, p = 0.18), whereas it was more evident, although weak, in adults (r = -0.14, p < 0.007). For a given level of end-systolic stress, endocardial shortening decreased by 0.32%/year in children and adolescents (multiple r = 0.51, p < 0.0001) and by 0.05%/year in adults, whereas midwall shortening decreased by 0.26%/year during body growth and by 0.02%/year in adults. CONCLUSIONS: In the presence of normal blood pressure and normal weight, the relations between left ventricular wall stress and both chamber and myocardial function are weakly but significantly influenced by age. Left ventricular chamber function is markedly influenced by wall stress, while this influence is reduced for left ventricular wall mechanics.

Adolescent↗