produces an exaggerated A wave. The augmented atrial contraction is accompanied by atrial hypertrophy and enlargement and on auscultation is manifested as a fourth heart sound (atrial gallop). Multiple regression analyses indicate that age is the major determinant of the E: A ratio; hence, the age-associated decrease in the Doppler transmittal E: A ratio is identical in healthy Baltimore Longitudinal Study on Aging (BLSA) participant and in Framingham Study participants15, 16 (Figure 2D).

Despite the age-associated changes in the diastolic filling pattern in older, healthy persons, their left ventricular end-diastolic volume index (end-diastolic volume normalized for body surface area [EDVI]) in the supine position is not compromised and does not substantially differ from their younger counterparts. 17, 18 Altered responses of cardiac volumes to postural maneuvers are associated with aging. Assumption of the sitting position from the supine position reduces EDVI in younger persons to a greater extent than in older ones. 17 During short-term submaximal seated cycle exercise, EDVI increases equivalently at all ages, but during exhaustive exercise, EDVI drops to the seated rest level in younger men but remains elevated in older men. 17 Thus, the average, acute, dynamic EDV reserve during the postural change and during graded upright exercise is moderately