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Echocardiographic evaluation of cardiac structure and function in elderly subjects with isolated systolic
A C Pearson1, C Gudipati, D Nagelhout
1Department of Internal Medicine, University Hospital, St. Louis University School of Medicine, Missouri.
Insights
Isolated systolic hypertension in the elderly is linked to increased left ventricular mass and atrial size. Diastolic filling patterns are altered, but systolic function remains normal.
Area of Science:
- Cardiology
- Gerontology
- Hypertension Research
Background:
- Isolated systolic hypertension (ISH) is common in the elderly.
- Understanding cardiac structural and functional changes in ISH is crucial for management.
Purpose of the Study:
- To investigate cardiac structural and functional alterations in elderly individuals with isolated systolic hypertension.
- To compare echocardiographic findings in ISH patients with age-matched normotensive controls.
Main Methods:
- Doppler echocardiography was used to examine 104 participants from the Systolic Hypertension in the Elderly Program (SHEP) trial.
- Patients with ISH (systolic BP > 160 mmHg, diastolic BP < 90 mmHg) were compared to 55 age-matched normotensive controls.
Main Results:
- ISH participants showed significantly higher left ventricular mass index (103 vs. 87 g/m², p=0.0014), with 26% meeting criteria for left ventricular hypertrophy.
- Left atrial index was greater in ISH patients (2.26 vs. 2.11 cm/m², p=0.005), and 51% had left atrial enlargement.
- Diastolic filling differed, with higher peak atrial velocity and a lower ratio of peak early to atrial velocity in ISH patients. No significant difference in systolic function was observed.
Conclusions:
- Elderly individuals with isolated systolic hypertension exhibit significant cardiac structural changes, including increased left ventricular mass and left atrial size.
- Diastolic dysfunction is present in ISH, characterized by altered filling patterns.
- Systolic cardiac function is preserved in this population despite the presence of isolated systolic hypertension.
Abstract:
One hundred four participants in the Systolic Hypertension in the Elderly Program (SHEP) trial (mean age 71 +/- 6 years) were examined by Doppler echocardiography to gain information on the cardiac structural and functional alterations in isolated systolic hypertension. Participants had a systolic blood pressure greater than 160 mm Hg with diastolic blood pressure less than 90 mm Hg and were compared with 55 age-matched normotensive control subjects. Left ventricular mass index was significantly higher in the participants than in the normotensive subjects (103 +/- 28 versus 87 +/- 23 g/m2, p = 0.0014) and 26% of the participants met echocardiographic criteria for left ventricular hypertrophy compared with 10% of normotensive subjects. Left atrial index was also greater in participants than in normotensive subjects (2.26 +/- 0.32 versus 2.11 +/- 0.24 cm/m2, p = 0.005) and 51% of participants had left atrial enlargement. Doppler measures of diastolic filling were significantly different between the two groups, with peak atrial velocity higher (76 +/- 17 versus 69 +/- 17 cm/s, p = 0.02) and ratio of peak early to atrial velocity lower (0.76 +/- 0.23 versus 0.86 +/- 0.22, p = 0.0124) in participants. There was no correlation between left ventricular mass index and Doppler measures of diastolic function, but relative wall thickness correlated significantly with peak atrial velocity (r = 0.22, p = 0.016) and peak early to peak atrial velocity ratio (r = 0.24, p = 0.007). There was no difference in M-mode ejection phase indexes of systolic performance (shortening fraction and peak velocity of circumferential fiber shortening) between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)