Elsevier

Mayo Clinic Proceedings

Volume 63, Issue 2, February 1988, Pages 137-146
Mayo Clinic Proceedings

Age-Related Changes in Normal Human Hearts During the First 10 Decades of Life. Part II (Maturity): A Quantitative Anatomic Study of 765 Specimens From Subjects 20 to 99 Years Old

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Heart weights, ventricular wall thicknesses, and valve circumferences were measured in 765 autopsy specimens from normal hearts from persons 20 to 99 years old. Body weight was a better predictor of normal heart weight than was body surface area or height, and mean heart weights were greater in men than in women at all ages. When heart weights were indexed (divided by body surface area), the mean values per decade increased significantly in women between the 3rd and 10th decades of life (P<0.01) but remained relatively constant with time in men. We found no significant differences in ventricular wall thicknesses between men and women. Although indexed mean values for left and right ventricular wall thicknesses remained relatively constant in all decades, ventricular septal thickness increased significantly between the 3rd and 10th decades of life (P<0.001). Beyond the seventh decade of life, the mean ratio of septal to left ventricular free wall thicknesses exceeded 1.20, and the upper 95% confidence limit exceeded 1.50—an important consideration in evaluation of hypertrophic cardiomyopathy in elderly patients. Mean valve circumferences were usually greater in men than in women, but the opposite pertained when values were indexed by body surface area. In both sexes, all indexed mean valve circumferences increased progressively throughout adult life, although this trend was greater for semilunar than for atrioventricular valves. The mean circumference of the aortic valve surpassed that of the pulmonary valve in the 4th decade and approached that of the mitral valve by the 10th decade of life. Thus, in evaluation of annuloaortic ectasia, investigators should take into account the normal age-related changes in aortic valve dimensions.

Section snippets

METHODS

Specimens of normal hearts, from autopsies performed between 1960 and 1982, were obtained as previously described.21, 22 Specimens in which the severity of coronary atherosclerosis was grade 3 or 4 (that is, reduction of luminal cross-sectional area by more than 50%) were excluded from the study.

Among the available specimens, the most recently obtained hearts from 50 men and 50 women in each of the third through the ninth decades of life were reviewed. In the 10th decade, normal hearts were

RESULTS

Statistically significant age-related changes were identified for all cardiac measurements. Moreover, significant sex-dependent differences were identified for heart weights and valve circumferences but not for ventricular wall thicknesses.

DISCUSSION

Although numerous quantitative autopsy studies of normal cardiac dimensions have been published (Table 1),11, 12, 13, 14, 15, 16, 17, 18, 19, 20 to our knowledge only two such reports have included data concerning not only heart weight but also both ventricular wall thicknesses and valvular circumferences,14, 15 and none has included large numbers of specimens from elderly persons. In the current investigation, these three sets of measurements were recorded from 765 normal human hearts obtained

Heart Weight.

Heart weight is related to body size and may be predicted on the basis of body height, weight, or surface area. Mean heart weights in the current investigation (Table 2, Table 3) show excellent agreement (that is, less than 5% difference) with those in other studies based on body weight11 and height.12 Moreover, results of our study indicate that body weight and surface area are better univariate predictors of normal heart weight than is body height. When matched for age and body size, however,

Ventricular Wall Thicknesses.

In the current study, measurements of ventricular wall thicknesses for the third through seventh decades of life correspond well with those reported in adults by other investigators. The mean thickness of the right ventricular free wall was 3.8 mm (SD, 0.9 mm) in our study and 3.9 mm13 and 4.0 mm14, 15 in other studies, and that of the left ventricular free wall was 12.3 mm (SD, 1.6 mm) in the current investigation and 12.6 mm18 and 15.0 mm13, 15 in other reports. The mean ventricular septal

Valve Circumferences.

Cardiac valve circumferences, measured in autopsy specimens, have been published in four previous studies14, 15, 16, 20 and were reported to increase progressively with advancing age to the ninth decade of life.16 In the current investigation, the tendency of the aortic and pulmonary valves to dilate progressively with increasing age was clearly established. In fact, by the 10th decade of life, the circumference of the aortic valve approached that of the mitral valve. In contrast, the tricuspid

ACKNOWLEDGMENT

We thank Chu-Pin Chu, Department of Health Sciences Research, for help with the statistical analyses in this study.

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