Key result
Aging from 85 to 94 years preserves LVEF and LV mass despite declining longitudinal function.
Why the study?
Longitudinal data assessing cardiac structure and function are necessary to distinguish physiologic from pathologic cardiac aging in people over age 85, a group with a high incidence of CHF.
What are the longitudinal changes in cardiac structure and function in the very elderly from age 85 to 94?
Cohort (n=63)
What are the longitudinal changes in cardiac structure and function in the very elderly from age 85 to 94?
In the very elderly, aging from 85 to 94 years is associated with preserved ejection fraction but decreased longitudinal systolic and diastolic function without significant changes in LV mass.
Answers are grounded in this paper and cite their sources.
Preserved EF may mask longitudinal decline in nonagenarians; leaves open whether strain monitoring improves risk stratification or outcomes.
Background People over the age of 85 are a rapidly growing age group with a high incidence of congestive heart failure (CHF), in particular heart failure with preserved ejection fraction (HFpEF). The diagnosis of CHF is challenging and longitudinal data assessing cardiac structure and function are necessary to distinguish physiologic from pathologic cardiac aging. The objective of the study was to determine longitudinal changes in cardiac struture and function from ages 85 to 94 years using home echocardiography. Methods Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Sixty three members of the initial cohort (32F, 31M) who underwent home echocardiography at age 85 were the subjects of the current study and underwent repeat home 2-D and Doppler echocardiographic assessment at age 94. Results There were no significant longitudinal changes in left ventricular mass index (LVMI), however LV end-diastolic volume significantly decreased from 113.4 ± 30 to 103.6 ± 35.5 mL (P < 0.02). Ejection fraction (EF) remained stable, however longitudinal systolic function significantly decreased with age from 7.9 ± 1.8 to 6.6 ± 1.4 cm/s2 (P < 0.0001). Diastolic function as assessed by increased E: e' (11.2 ± 3.4 to 16 ± 7.5, P < 0.0001) and increased left atrial volume index (34.1 ± 11.3 to 42.4 ± 13.7 mL/m2, P < 0.0001) was reduced with aging. Conclusions This study demonstrated preserved EF with decreased longitudinal systolic function and diastolic function without significant change in LV mass. Changes in LV function in the very elderly may be independent of changes in LV geometry.
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Leibowitz et al. (2019) conducted a cohort in Cardiac aging in the very elderly (n=63). Aging from 85 to 94 years vs. Baseline cardiac function at age 85 was evaluated on Longitudinal changes in cardiac structure and function (including longitudinal systolic function, E:e', left atrial volume index, and LV end-diastolic volume) (p=<0.0001). Aging from 85 to 94 years decreased longitudinal systolic function (7.9 to 6.6 cm/s2, P<0.0001) and worsened diastolic function (E:e' 11.2 to 16, P<0.0001) despite preserved ejection fraction.
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