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Cross-sectional echocardiography: a window on congestive heart failure in the elderly
A Cocchi1, G Zuccalà, D Del Sindaco
1Department of Geriatrics, Catholic University, Rome, Italy.
Insights
Ultrasonic cardiac imaging, or echocardiography, is feasible in elderly patients with congestive heart failure (CHF). Echocardiography provides valuable diagnostic information often missed by other methods, aiding in CHF evaluation.
Area of Science:
- Cardiology
- Medical Imaging
- Geriatrics
Background:
- Congestive heart failure (CHF) diagnosis and management in the elderly can be challenging due to atypical presentations.
- The utility of echocardiography in this specific demographic remains incompletely defined.
Purpose of the Study:
- To assess the feasibility and diagnostic yield of echocardiography in elderly patients with chronic CHF.
- To explore the relationship between left ventricular systolic function and clinical parameters in this population.
Main Methods:
- A survey of 154 consecutive elderly patients with chronic CHF.
- Echocardiographic assessment of cardiac structure and function.
- Correlation of echocardiographic findings with clinical data.
Main Results:
- Satisfactory echocardiographic imaging was achieved in 77% of patients.
- All echocardiograms revealed abnormalities, including left ventricular mass increase (70%), dilation (68%), and valvular disease (40%).
- Echocardiography identified previously undiagnosed conditions like silent coronary artery disease (26 cases) and valvular disease (22 cases).
Conclusions:
- Echocardiography is a valuable tool for evaluating elderly CHF patients, often revealing critical information missed by clinical assessment, chest X-ray, and ECG.
- Despite normal ejection fraction in 44% of cases, echocardiography provides essential structural and functional insights for CHF management in the elderly.
Abstract:
The value and limits of ultrasonic cardiac imaging in elderly patients with congestive heart failure (CHF) are not yet fully known. We report the results of an echocardiographic survey on 154 consecutive elderly persons with chronic CHF. The aim of this study was to establish the feasibility and the diagnostic yield of echocardiography in this population, and the relationship, if any, between left ventricular systolic function and main clinical parameters. Satisfactory cardiac imaging was achieved in 118 patients (77%). All patients had abnormal echocardiograms, although no single abnormal finding was present in all the cases. Echocardiography (ECHO) confirmed 147 previously diagnosed CHFs, and further detected a silent coronary artery disease in 26 cases, a valvular disease in 22, and an atrial septal defect in one patient. The most frequent findings were left ventricular (LV) mass increase and dilation (70% and 68%, respectively), and mostly degenerative valvular disease (40%). The LV ejection fraction was within normal limits in 44% of the cases. Although a depressed LV systolic function was more common among patients in III or IV NYHA class, no clinical parameters could identify the 52 patients with normal ejection fraction. Thus, ECHO could play a key role in evaluating CHF in elderly patients. In these patients, due to misleading signs and symptoms, and to multiple CHF etiologies, basic structural and functional features are frequently missed by clinical investigation, chest x-ray and electrocardiography.