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[Congestive heart failure in the elderly. Value of Doppler echocardiography]
F Puisieux1, P de Groote, J B Lemaire
1Service de médecine interne et de gériatrie, CHRU de Lille, France.
Insights
Congestive heart failure in the elderly often presents with normal systolic function. Doppler echocardiography, particularly mitral deceleration time (MDT) and isovolumic relaxation time (IRT), effectively diagnoses diastolic dysfunction in this population.
Area of Science:
- Cardiology
- Geriatrics
- Medical Imaging
Background:
- Congestive heart failure (CHF) is a significant health concern in the elderly.
- Distinguishing between systolic and diastolic dysfunction is crucial for effective CHF management.
- Clinical assessment alone has low sensitivity for identifying specific cardiac dysfunctions in older adults.
Purpose of the Study:
- To determine the prevalence of CHF with preserved left ventricular systolic function in elderly patients.
- To assess the role of left ventricular diastolic dysfunction in elderly CHF.
- To evaluate the efficacy of Doppler echocardiography parameters (E/A, MDT, IRT) for diagnosing diastolic dysfunction.
Main Methods:
- Prospective investigation of 58 elderly patients admitted for CHF using Doppler echocardiography.
- Assessment of left ventricular systolic function.
- Evaluation of diastolic function using E/A ratio, mitral deceleration time (MDT), and isovolumic relaxation time (IRT).
Main Results:
- 55% of elderly CHF patients exhibited normal left ventricular systolic function.
- Among those with normal systolic function, 16 out of 23 (69.5%) had abnormal diastolic function.
- Mitral deceleration time (MDT) and isovolumic relaxation time (IRT) demonstrated higher sensitivity than the E/A ratio for diagnosing diastolic dysfunction in the elderly.
Conclusions:
- Congestive heart failure with normal systolic function is highly prevalent in the elderly.
- Doppler echocardiography is a valuable, non-invasive tool for assessing both systolic and diastolic cardiac function in older adults.
- MDT and IRT are more reliable echocardiographic markers than E/A for identifying diastolic dysfunction in elderly CHF patients.
Abstract:
Fifty-eight consecutive elderly patients (seven men and 51 women, mean age 84 +/- 6) admitted for congestive heart failure were prospectively investigated by doppler echocardiography in order to 1) define the prevalence of cardiac failure with normal left ventricular systolic function, 2) estimate the role of abnormalities of left ventricular filling (diastolic dysfunction), 3) evaluate echodoppler parameters for assessment of diastolic function: ratio of early peak on atrial peak of filling velocities (E/A), mitral deceleration time (MDT) and isovolumic relaxation time (IRT). Of the 58 patients, 32 (55%) had normal left ventricular systolic function and 26 (45%) had systolic dysfunction. Of the 32 patients with normal systolic function, diastolic function could not be evaluated in nine patients, was abnormal in 16 and normal in seven. Congestive heart failure with normal systolic function is very frequent in the elderly subject. Sensitivity of clinical data being too low, doppler echocardiography is the easiest noninvasive technique for defining abnormalities of both left ventricular systolic and diastolic function. In the elderly, MDT and IRT are more sensitive parameters than E/A for the diagnosis of diastolic dysfunction.