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Hypertrophic cardiomyopathy in the elderly. Distinctions from the young based on cardiac shape
H M Lever1, R F Karam, P J Currie
1Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195-5210.
Insights
Hypertrophic cardiomyopathy in the elderly presents similarly to younger patients, though with distinct left ventricular shapes and normal septal curvature. This study highlights age-related differences in cardiac morphology for this condition.
Area of Science:
- Cardiology
- Geriatric Medicine
- Medical Imaging
Background:
- Hypertrophic cardiomyopathy (HCM) is well-defined in younger populations.
- Limited data exists on HCM presentation and characteristics in elderly individuals.
Purpose of the Study:
- To compare clinical and echocardiographic features of hypertrophic cardiomyopathy in elderly patients (≥65 years) versus younger adults (<40 years).
Main Methods:
- Retrospective analysis of 28 elderly HCM patients and 28 younger HCM patients.
- Utilized M-mode, 2D, and Doppler echocardiography for assessment.
- Cardiac catheterization was performed in select cases.
Main Results:
- No significant clinical differences, except for mild hypertension in the elderly.
- Both groups showed left ventricular hypertrophy and small cavity size.
- Elderly group exhibited ovoid left ventricular cavities with normal septal curvature.
- Younger group displayed abnormal cardiac shapes, including crescent-shaped cavities and reversed septal curvature (p<0.0001).
- Prominent right ventricular free wall observed in younger patients (p<0.001).
Conclusions:
- Hypertrophic cardiomyopathy in the elderly shares clinical features with younger patients.
- Significant differences in left ventricular size and shape exist between elderly and younger HCM cohorts.
- Age influences the specific cardiac morphology observed in hypertrophic cardiomyopathy.
Abstract:
The striking clinical and pathologic features of hypertrophic cardiomyopathy have been defined almost exclusively in the young. Little is known about this condition in the elderly, although it is assumed to be part of a single disease. Accordingly, we studied 28 patients who were 65 years of age and older (mean age, 72 +/- 6.4 years) who were diagnosed as having hypertrophic cardiomyopathy by M-mode, two-dimensional, and Doppler echocardiography and compared them with a group of 28 consecutive patients with this disease who were younger than 40 years of age (mean age, 26 +/- 9.5 years). No clinically detectable differences existed between the two groups, except for an increased incidence of mild hypertension in the elderly. Echocardiography in both groups showed hypertrophy with a small left ventricular cavity, and Doppler outflow tract velocity or cardiac catheterization in most patients showed systolic anterior motion of the mitral valve or a systolic outflow tract gradient or both. Significant differences existed between both groups, however, concerning left ventricular size and shape. The elderly group had a predominantly ovoid cavity contour with normal septal curvature. In contrast, in the young group, a markedly abnormal cardiac shape predominated (p less than 0.0001) with a crescent-shaped left ventricular cavity and a reversed curvature of the interventricular septum. The right ventricular free wall was prominent by echocardiography in the young compared with the elderly group (p less than 0.001). Apart from a more frequent history of mild hypertension in the elderly, likely related to age, these findings show that hypertrophic cardiomyopathy, when present in the elderly, has similar clinical features to that in the young.(ABSTRACT TRUNCATED AT 250 WORDS)