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Cardiac Structure and Function in Persons 85 Years of Age

https://doi.org/10.1016/j.amjcard.2011.03.070Get rights and content

Individuals aged >85 years constitute the world's most rapidly growing age group. Despite the rapid growth of this population and its high incidence of cardiovascular morbidity, normative data concerning cardiac structure and function are limited. The objective of this study was to define cardiac structure and function in an age-homogenous, community-dwelling population of subjects born in 1920 and 1921. Subjects were recruited from the Jerusalem Longitudinal Cohort Study. Echocardiography was performed using a portable echocardiograph at the subject's place of residence. Standard echocardiographic assessment of cardiac structure and function was performed. Four hundred fifty subjects (219 men, 231 women) were enrolled in the study. The cohort exhibited large left atrial volumes (64.6 ± 26 ml) and high left ventricular (LV) mass indexes (122 ± 36 g/m2) with normal LV volumes. Ejection fractions were preserved (55.3 ± 10.2%), but tissue Doppler s-wave velocities (lateral 7.8 ± 2.1 cm/s, septal 6.7 ± 1.9 cm/s) were reduced. Reduced tissue Doppler e waves (lateral 7.3 ± 2.2 cm/s, septal 6.2 ± 2 cm/s) and elevated E/e′ ratios (12.2 ± 4.9) indicated significantly impaired diastolic function. In conclusion, the findings of this study demonstrate a high prevalence of left atrial enlargement, elevated LV mass, evidence of LV systolic dysfunction with preserved ejection fractions, and significant LV diastolic dysfunction in a community-dwelling cohort of 85-year-olds. The finding of elevated E/e′ ratios in a subset free of known cardiovascular disease should be considered when clinical assessment of LV diastolic dysfunction in this age group is performed.

Section snippets

Methods

Subjects were recruited from the Jerusalem Longitudinal Cohort Study, which was initiated in 1990 and has followed an age-homogenous cohort of West Jerusalem residents born from June 1920 to May 1921. The method has been described elsewhere in detail.2, 3 In the present study, we examined data from the third most recent phase of data collection, which took place during 2005 and 2006. Subjects were interviewed and examined in their homes on 2 separate occasions, each session requiring the

Results

Of the 450 subjects, 219 were men and 231 were women. Clinical characteristics of the study group are listed in Table 1. Most of the sample (77%) was of Ashkenazi (European) Jewish origin, with 23% of Sephardic (Middle Eastern or North African) Jewish origin. The average body mass index in our cohort was 27.1 mg/kg2, slightly lower than that noted in other Western populations. There was a high prevalence of hypertension and ischemic heart disease, as expected in this elderly cohort, but most

Discussion

In this study, we define for the first time cardiac morphology, systolic function, and diastolic function in a representative sample of a community-dwelling cohort of 85-year-olds. This cohort demonstrated enlarged left atria as well as very elevated LV mass, with significant concentric remodeling. We confirm previous findings regarding general age-related deterioration of diastolic function in this very elderly cohort not previously well studied and provide new insight into systolic

References (30)

  • F.A. Masoudi et al.

    Gender, age and heart failure with preserved left ventricular systolic function

    J Am Coll Cardiol

    (2003)
  • C.M. Yu et al.

    Tissue Doppler imaging: a new prognosticator for cardiovascular diseases

    J Am Coll Cardiol

    (2007)
  • J. Stessman et al.

    The Jerusalem 70-Year-Old Longitudinal StudyI: description of the initial cross sectional survey

    Eur J Epidemiol

    (1995)
  • J.M. Jacobs et al.

    Cohort profile: the Jerusalem Longitudinal Cohort Study

    Int J Epidemiol

    (2009)
  • S. Katz et al.

    Studies of illness in the agedThe index of ADL: a standardized measure of biological and psychosocial function

    JAMA

    (1963)
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    This work was supported by funds from the Ministry of Labor and Social Affairs of the State of Israel, Jerusalem, Israel; the Association for the Planning and Development of Services for the Aged in Israel, New York, New York; the National Insurance Institute, Jerusalem, Israel; and various private charitable donors.

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