Normal age-related changes in left ventricular function: Role of afterload and subendocardial dysfunction Jehill D. Parikh, Kieren G. Hollingsworth,

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Normal age-related changes in left ventricular function: Role of afterload and subendocardial dysfunction Jehill D. Parikh, Kieren G. Hollingsworth, Dorothy Wallace, Andrew M. Blamire, Guy A. MacGowan International Journal of Cardiology Volume 223, Pages 306-312 (November 2016) DOI: 10.1016/j.ijcard.2016.07.252 Copyright © 2016 The Authors Terms and Conditions

Fig. 1 Illustration of epicardial torsion and endocardial circumferential shortening used in the calculation of the torsion to shortening ratio (TSR) and the relationship to subepicardial and subendocardial fibre orientations. Epicardium is black and endocardium grey. A. Obliquely oriented subepicardial fibres produce rotation of the apex with respect to the base (B.) in a counterclockwise direction when looking from the apex to base, which is quantified in terms of the circumferential-longitudinal shear angle (C.). Epicardial torsion acts on the subendocardium with its greater mechanical advantage due to its larger radius, forcing subendocardial fibre bundles to shorten in a direction at almost 90o away from the subendocardial fibre direction (D.). This subepicardial to subendocardial interaction is quantified as the torsion to shortening ratio (TSR), and an increase in the TSR suggests subendocardial dysfunction relative to the subepicardium. International Journal of Cardiology 2016 223, 306-312DOI: (10.1016/j.ijcard.2016.07.252) Copyright © 2016 The Authors Terms and Conditions

Fig. 2 Vascular function and afterload in healthy ageing. Scatter plots describing arterial function with age, along with Pearson's correlation (r) and significance level (p). Arterial elastance, augmentation index, Vicorder PWV and Central MR PWV all increase with age. International Journal of Cardiology 2016 223, 306-312DOI: (10.1016/j.ijcard.2016.07.252) Copyright © 2016 The Authors Terms and Conditions

Fig. 3 Left ventricular function in healthy ageing. Scatter plots along with Pearson's correlation (r) and significance level (p) demonstrating impaired in left ventricular function in age, with declining cardiac output, end diastolic volume index (EDVi), early to late filling ratio (E/A ratio), and increasing torsion to shortening ratio (TSR). International Journal of Cardiology 2016 223, 306-312DOI: (10.1016/j.ijcard.2016.07.252) Copyright © 2016 The Authors Terms and Conditions