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Age-associated changes in diastolic filling: Doppler E/A ratio is not associated with congestive heart failure in the
P R Marantz1, J N Tobin, C A Derby
1Department of Medicine, Montefiore Medical Center, Bronx, NY.
Insights
Diastolic filling delay is common in older adults but does not correlate with congestive heart failure (CHF). This finding suggests further research is needed to understand the clinical significance of this common age-related change in cardiac function.
Area of Science:
- Cardiology
- Geriatrics
- Echocardiography
Background:
- Left ventricular filling patterns change with age, often occurring later in diastole.
- The clinical relevance of delayed diastolic filling in the elderly remains unclear.
- Congestive heart failure (CHF) is a significant concern in the aging population.
Purpose of the Study:
- To investigate the prevalence of diastolic filling delay in community-dwelling elderly individuals.
- To determine the relationship between diastolic filling delay and the presence of congestive heart failure (CHF) in this population.
- To assess the correlation between Doppler echocardiographic measures of diastolic function and CHF severity.
Main Methods:
- A cohort of 114 elderly volunteers (median age 75) underwent clinical assessment, chest X-ray, and Doppler echocardiography.
- Diastolic filling was evaluated using the early to late transmitral flow velocity (E/A) ratio.
- Congestive heart failure (CHF) was diagnosed using a validated clinico-radiographic scoring system.
Main Results:
- Diastolic filling delay (E/A < 1) was highly prevalent, observed in 82% of subjects.
- No significant association was found between diastolic filling delay and the presence or severity of CHF.
- Systolic function (ejection fraction) was preserved in the majority of the study participants (97%).
Conclusions:
- Despite its high prevalence in the elderly, diastolic filling delay does not appear to be directly associated with congestive heart failure (CHF).
- The clinical significance and prognostic value of age-related diastolic filling changes require further investigation through prospective studies.
- Current findings suggest that diastolic filling delay alone is not a reliable indicator of CHF in the elderly population.
Abstract:
Although left ventricular filling tends to occur in late diastole in the elderly, the clinical significance of this change is unclear. To determine the prevalence of diastolic filling delay and its relationship to congestive heart failure (CHF) in the elderly, we studied 114 community-living elderly volunteers (median age 75, 37% male). Clinical history, physical examination, chest x-ray film, and Doppler echocardiogram were obtained in blinded fashion. CHF was diagnosed by a previously validated clinico-radiographic scoring system. Diastolic filling was assessed by the Doppler ratio of early to late transmitral flow velocity (E/A). The standard clinical definition of diastolic filling delay (E/A < 1) was met by 94 subjects (82%), and median E/A was 0.72; for this study, diastolic filling delay was defined at the median, although both approaches yielded similar results. Systolic function was normal (ejection fraction > or = 0.5) in 97%. There were 22 subjects (19%) with definite or possible CHF. Older subjects were more likely to have CHF, but not more likely to have an E/A ratio below the median. Subjects with diastolic filling delay were no more likely to have CHF than those without. Mean E/A was not different between CHF groups, and there was no significant correlation between E/A and CHF score. There was still no association after controlling for age, history of hypertension, and other potential confounders by multiple logistic regression. Although diastolic filling delay is common in the elderly, it does not correlate with signs and symptoms of CHF. Determination of its prognostic significance requires a prospective follow-up study.