Cardiac Structure and Function in Persons 85 Years of Age

Leibowitz, David; Stessman-Lande, Irit; Jacobs, Jeremy M.; Cohen, Arthur; Weiss, A. Teddy; Ein-Mor, Eliana; Stessman, Jochanan; Gilon, Dan

doi:10.1016/j.amjcard.2011.03.070

Cited by 18 publications

(19 citation statements)

References 28 publications

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“…The Leiden study highlights the selection bias introduced by hospital based assessment in the very old; only 30% of those eligible were able to attend hospital for echocardiographic assessment and those who attended were significantly healthier than those who could not 22. Our findings are comparable to the recently reported Jerusalem study (n=450, aged 85 years) which reported 44% with EF less than 55% and 14% with EF less than 45% 23. The prevalence of severe systolic dysfunction in our study is also broadly comparable with previous studies by Raymond et al 24 and the Rotterdam study group,25 both of which focused on more severe systolic dysfunction.…”

Section: Discussionsupporting

confidence: 64%

Prevalence of left ventricular dysfunction in a UK community sample of very old people: the Newcastle 85+ study

Yousaf

Collerton

Kingston

et al. 2012

Heart

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ObjectiveHeart failure (HF) prevalence rises sharply among those aged 85 years and over. Previous population based echocardiographic studies of left ventricular (LV) dysfunction, the substrate for HF, have included only small numbers in this age group. We used domiciliary echocardiography to estimate the prevalence of LV systolic and diastolic dysfunction in 87–89 year olds and the proportion remaining undiagnosed.DesignCross sectional analysis of data from Newcastle 85+ Study.SettingPrimary care, North-East England.Participants376 men and women aged 87–89 years.MeasuresDomiciliary echocardiography was performed and LV systolic and diastolic function was graded. The presence of limiting dyspnoea was assessed by questionnaire. Previous diagnoses of HF were abstracted from general practice (GP) records.Results32% of participants (119/376) had LV systolic dysfunction (ejection fraction (EF) ≤50%) and a further 20% (75/376) had moderate or severe LV diastolic dysfunction with preserved EF. Both echocardiographic assessment of LV function and dyspnoea status were available in 74% (278/376) of participants. Among these participants, limiting dyspnoea was present in approximately two thirds of those with significant (systolic or isolated moderate/severe diastolic) LV dysfunction. 84% (73/87) of participants with significant LV dysfunction and limiting dyspnoea did not have a pre-existing HF diagnosis in their GP records. Overall, 26% (73/278) of participants with both echocardiographic and dyspnoea data had undiagnosed, symptomatic, significant LV dysfunction.ConclusionSignificant systolic and diastolic LV dysfunction is much commoner in community dwelling 87–89 year olds than previous studies have suggested. The majority are both symptomatic and undiagnosed.

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Section: Discussionsupporting

confidence: 64%

Prevalence of left ventricular dysfunction in a UK community sample of very old people: the Newcastle 85+ study

Yousaf

Collerton

Kingston

et al. 2012

Heart

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“…The clinical differences detected in patients with compared with those without diastolic dysfunction included significantly older age, more prevalent severe ascites and higher heart rate. Advanced age is a factor previously shown to be correlated to diastolic dysfunction [24]. Patients with diastolic dysfunction had a more prominent hyperdynamic circulatory state as indicated by higher heart rate.…”

Section: Discussionmentioning

confidence: 99%

Diastolic myocardial dysfunction does not affect survival in patients with cirrhosis

Alexopoulou

Papatheodoridis

Pouriki

et al. 2012

Transplant International

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Summary Left ventricular diastolic dysfunction (DDF) has been considered as a component of cirrhotic cardiomyopathy. The clinical significance of DDF in cirrhotics has not been clarified. We prospectively evaluated the echocardiographic‐Doppler, tissue‐Doppler (TDI) findings of left ventricular function and survival in cirrhotics with or without DDF. Seventy‐six cirrhotics without endogenous heart disease were included. DDF was diagnosed by mitral inflow Doppler parameters and diastolic myocardial velocities. Assessments of demographics, liver dysfunction, laboratory, echocardiographic systolic/diastolic indices, TDI of mitral annular motion and M‐mode echocardiography were recorded. Patients were followed‐up for a median of 25 months (15–40). DDF was diagnosed in 51 (67%) patients. Patients with compared with those without DDF had significantly older age and higher pulse rate as well as more frequently severe ascites, greater aortic root diameter and interventricular septal thickness. There was no difference in systolic myocardial function between two groups. Patients with DDF had a trend for worse survival (long rank, P = 0.094). A multivariate analysis showed that age, MELD and sodium but no DDF were predictive of death. DDF is prevalent in advanced cirrhosis and is associated with severe ascites. Systolic myocardial function and mortality do not seem to be strongly affected by the presence of DDF.

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“…Aging is associated with vascular calcification and stiffening and pathological studies have shown that this is also the case for the pulmonary circulation [19,20]. In addition, we and other authors have demonstrated an age-related decrease in diastolic function which may contribute to elevated left-sided filling pressures and secondary pulmonary hypertension [21,22] Shapiro et al [23 ]described a high incidence of elevated pulmonary capillary wedge pressure in elderly patients who were being evaluated for unexplained pulmonary hypertension; this supports the theory that left-sided heart failure is an important mechanism in this population. Our finding of an association between E:e' and RVSP support this contention.…”

Section: Discussionmentioning

confidence: 81%

Pulmonary Artery Systolic Pressure and Mortality in the Oldest Old

et al. 2014

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Objectives: The objectives of the study were to assess pulmonary artery systolic pressure, its association with clinical and echocardiographic variables and its impact on 5-year mortality in a community-dwelling population of the oldest old. Methods: Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Echocardiography was performed at home, with standard measurements being taken including tricuspid regurgitation (TR) velocity (n = 300). Survival status at 5-year follow-up was assessed via the centralized population registry. Results: The mean TR gradient in the study population as a whole was 30.5 ± 9.4 mm Hg. A significant relationship was noted between right-ventricular systolic pressure (RVSP) and left-atrial (LA) volume (r = 0.27, p < 0.0001), left-ventricular (LV) mass index (r = 0.26, p < 0.0001) and the ratio E/e (r = 0.19, p < 0.03). At the 5-year follow-up, 71 of the 300 subjects (23.7%) had died. TR gradient was significantly associated with mortality in both the unadjusted (HR 1.036, 95% CI 1.015-1.058; p < 0.007) and adjusted (HR 1.036, 95% CI 1.012-1.061; p < 0.0029) models. Conclusions: We demonstrate that RVSP is elevated and related to LV mass, LA volume and reduced diastolic function in the oldest old. An elevated RVSP is significantly associated with mortality in this population.

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Cardiac Structure and Function in Persons 85 Years of Age

Cited by 18 publications

References 28 publications

Prevalence of left ventricular dysfunction in a UK community sample of very old people: the Newcastle 85+ study

Prevalence of left ventricular dysfunction in a UK community sample of very old people: the Newcastle 85+ study

Diastolic myocardial dysfunction does not affect survival in patients with cirrhosis

Pulmonary Artery Systolic Pressure and Mortality in the Oldest Old

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