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Diastolic dysfunction in the elderly. Genesis and diagnostic and therapeutic implications
1Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA. dkitzman@wfubmc.edu
Insights
Aging significantly alters diastolic left ventricular function, impacting elderly cardiovascular health. Abnormal patterns like pseudo-normal and restricted are more easily identified in older adults, aiding diagnosis of diastolic heart failure.
Area of Science:
- Cardiology
- Geriatrics
- Medical Imaging
Background:
- Diastolic left ventricular function changes with age in healthy individuals.
- Diastolic dysfunction is a common factor in cardiovascular disorders among the elderly.
- Understanding age-related changes in diastolic function is crucial for geriatric cardiovascular health.
Purpose of the Study:
- To investigate alterations in diastolic left ventricular function in aging.
- To examine the diagnostic utility of Doppler filling patterns in elderly patients.
- To highlight the prevalence and characteristics of diastolic heart failure in the elderly.
Main Methods:
- Analysis of Doppler filling patterns in healthy older adults.
- Comparison of diastolic function parameters between young and elderly individuals.
- Identification and characterization of abnormal diastolic patterns (pseudo-normal, restricted) in the elderly.
Main Results:
- Older healthy individuals exhibit delayed relaxation Doppler filling patterns.
- Abnormal diastolic patterns (pseudo-normal, restricted) are more specific in the elderly.
- A significant portion of heart failure in the elderly presents as diastolic heart failure with preserved systolic function.
Conclusions:
- Diastolic left ventricular dysfunction is a key feature of cardiovascular aging.
- Doppler echocardiography can effectively identify specific diastolic abnormalities in older adults.
- Further research and standardized diagnostic criteria are needed for diastolic heart failure in the elderly.
Abstract:
Diastolic left ventricular function is altered substantially with advancing age in healthy persons, and diastolic dysfunction impacts most cardiovascular disorders in the elderly. Older, healthy persons have a delayed relaxation Doppler filling pattern and their early deceleration time is similar to, or modestly lengthened, compared with younger, healthy persons. Two abnormal Doppler filling patterns, the pseudo-normal and the restricted, are discerned more easily, and are more specific in the elderly than the young, because they are the opposite (reverse) of the normal elderly pattern. Most heart failure in the elderly occurs in the presence of preserved systolic function (presumed diastolic heart failure). Elderly patients with diastolic heart failure tend to be women with hypertrophied, hyperdynamic left ventricles, and chronic hypertension. Prognosis may be somewhat better than in systolic heart failure, but the difference diminishes when adjusted for gender and in the very elderly. The pathophysiology of this disorder is not well characterized, diagnostic criteria have not been standardized, and there are no large, multicenter, randomized trials to guide therapy. Further research in this area should be a high priority.