Key result
Existing ASE guidelines classify ~82% of healthy older adults as abnormal, failing to account for aging.
Why the study?
Echocardiographic thresholds distinguishing disease or impaired function from normal physiologic aging in individuals aged 65 years or older are not clearly defined.
Cross-Sectional (n=3,032)
Yes
Existing echocardiographic guidelines based on younger populations misclassify over 80% of healthy older adults as having cardiac abnormalities, highlighting the critical need for age-specific normative values.
Current thresholds risk overdiagnosis in older adults; challenges consensus and leaves open age-specific normative values.
Background: Echocardiographic (2DE) thresholds indicating disease or impaired functional status compared to normal physiologic aging in individuals ≥ 65 years are not clearly defined. In the present study, we sought to establish standard values for 2DE parameters related to chamber size and function in older adults without cardiopulmonary or cardiometabolic conditions. Methods: In this cross-sectional study of 3032 individuals who underwent 2DE at Exam 6 in the Multi-Ethnic Study of Atherosclerosis (MESA), 608 participants fulfilled our inclusion criteria, with normative values defined as the mean value ± 1.96 standard deviations and compared across sex and race/ethnicity. Functional status measures included NT-proBNP, 6-minute walk distance [6MWD], and Kansas City Cardiomyopathy Questionnaire [KCCQ]. Prognostic performance using MESA cutoffs was compared to established guideline cutoffs using time-to-event analysis. Results: Participants meeting our inclusion criteria (69.5 ± 7.0 years, 46.2% male, 47.5% White) had lower NT-proBNP, higher 6MWD, and higher (better) KCCQ summary values. Women had significantly smaller chamber sizes and better biventricular systolic function. White participants had the largest chamber dimensions, while Chinese participants had the smallest, even after adjustment for body size. Current guidelines identified 81.6% of healthy older adults in MESA as having cardiac abnormalities. Conclusions: Among a large, diverse group of healthy older adults, we found significant differences in cardiac structure and function across sexes and races/ethnicities, which may signal sex-specific cardiac remodeling with advancing age. It is crucial for existing guidelines to consider the observed and clinically significant differences in cardiac structure and function associated with healthy aging. Our study highlights that existing guidelines, which grade abnormalities in echocardiographic cardiac chamber size and function based on younger individuals, may not adequately address the anticipated changes associated with normal aging.
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Mukherjee et al. (2023) conducted a cross-sectional in Healthy aging (n=3,032). MESA age-specific echocardiographic cutoffs vs. ASE guideline cutoffs was evaluated on Proportion of healthy older adults classified as having cardiac abnormalities by existing ASE guidelines. Existing ASE guidelines classified 81.6% of healthy older adults as having cardiac abnormalities, demonstrating that current echocardiographic thresholds do not adequately account for normal aging.
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