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

David Leibowitz1,2, Irit Stessman-Lande2, Hend Sliman2

  • 1Jerusalem Institute of Aging Research, Hadassah-Hebrew University Medical Center, Mount-Scopus, Jerusalem, Israel.

Journal of Geriatric Cardiology : JGC
|December 20, 2019
PubMed

Insights

Very elderly individuals aged 85-94 show preserved ejection fraction (EF) but declining systolic and diastolic heart function. Cardiac structure, like left ventricular mass, remained stable, suggesting functional changes may occur independently of geometric alterations in aging hearts.

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.
Abstract

Keywords:
EchocardiographyThe elderlyVentricular function

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