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The significance of increased left ventricular outflow tract velocities in the elderly measured by continuous wave
A S Agatston1, R Polakoff, R Hippogoankar
1Mount Sinai Medical Center, Miami Beach, FL.
Insights
Elderly patients with elevated left ventricular outflow tract velocities often exhibit distinct cardiac characteristics and reduced diastolic function compared to younger individuals with hypertrophic cardiomyopathy.
Area of Science:
- Cardiology
- Geriatric Medicine
- Echocardiography
Background:
- Elderly patients can present with elevated left ventricular outflow tract (LVOT) velocities and gradients.
- These findings in older adults may be associated with specific cardiac structural and functional abnormalities.
Purpose of the Study:
- To characterize the clinical and echocardiographic features of elderly patients with elevated LVOT velocities.
- To compare the diastolic function of these elderly patients with younger hypertrophic cardiomyopathy (HCM) patients and age-matched controls.
Main Methods:
- Retrospective analysis of 44 elderly patients (mean age 80 years) with documented LVOT velocities and gradients.
- Echocardiographic assessment including left ventricular hypertrophy, dimensions, ejection fraction, and diastolic function.
- Comparison with a cohort of young HCM patients and healthy, age- and sex-matched controls.
Main Results:
- Elderly patients showed severe left ventricular hypertrophy, small end-diastolic dimensions, and supernormal ejection fractions.
- A high incidence of congestive heart failure and a history of hypertension were noted.
- Reduced diastolic function was observed in the elderly group compared to both young HCM patients and controls.
Conclusions:
- Elderly patients with elevated LVOT velocities represent a distinct clinical entity.
- These patients often present with concentric left ventricular hypertrophy and impaired diastolic function.
- Etiologically, they appear distinct from younger patients diagnosed with hypertrophic cardiomyopathy.
Abstract:
Forty-four elderly patients (mean age 80 +/- 7 years) with elevated left ventricular outflow tract velocities and corresponding outflow tract gradients documented by continuous wave Doppler are reported (mean peak gradient 50 +/- 28). They had severe left ventricular hypertrophy, small left ventricular end-diastolic dimensions, and supernormal ejection fractions. Thirty-nine percent had a history of hypertension. They were predominantly female, had uniform concentric left ventricular hypertrophy, and had a high incidence of congestive heart failure. Diastolic function was found to be reduced in the elderly group compared to young patients with hypertrophic cardiomyopathy and to age- and sex-matched normal controls. It is concluded that most elderly patients with increased left ventricular outflow tract velocities are etiologically distinct from young patients with hypertrophic cardiomyopathy.
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