Longitudinal changes in cardiac function in the very elderly: the Jerusalem longitudinal cohort study.

Area of Science:

• Cardiology
• Gerontology
• Echocardiography

Background:

• The population over 85 is growing, with high rates of congestive heart failure (CHF), particularly heart failure with preserved ejection fraction (HFpEF).
• Diagnosing CHF in the elderly is difficult; longitudinal data on cardiac structure and function are crucial for differentiating normal aging from pathological changes.
• This study aimed to track cardiac changes in individuals aged 85 to 94 using home echocardiography.

Purpose of the Study:

• To investigate longitudinal changes in cardiac structure and function in individuals aged 85 to 94.
• To assess the relationship between cardiac aging, cardiac structure, and cardiac function in the very elderly population.
• To determine if changes in left ventricular (LV) geometry influence functional decline in advanced age.

Main Methods:

• Sixty-three participants from the Jerusalem Longitudinal Cohort Study were assessed.
• Home 2-D and Doppler echocardiography was performed at age 85 and repeated at age 94.
• Key parameters measured included LV mass index, LV end-diastolic volume, ejection fraction, longitudinal systolic function, and diastolic function indices (E:e', left atrial volume index).

Main Results:

• Left ventricular mass index (LVMI) showed no significant longitudinal change.
• LV end-diastolic volume decreased significantly (113.4 to 103.6 mL).
• Ejection fraction (EF) remained stable, but longitudinal systolic function declined significantly (7.9 to 6.6 cm/s²).
• Diastolic function worsened, indicated by increased E:e' ratio (11.2 to 16) and left atrial volume index (34.1 to 42.4 mL/m²).

Conclusions:

• The very elderly (85-94 years) can maintain preserved ejection fraction despite age-related declines in systolic and diastolic heart function.
• Significant changes in LV function occurred without substantial alterations in LV mass, suggesting functional adaptations may be independent of geometric remodeling.
• These findings highlight the complex nature of cardiac aging in advanced years and the need for sensitive functional assessments.