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Comparison of cardiac findings at necropsy in octogenarians, nonagenarians, and centenarians
1Baylor Cardiovascular Institute, and the Department of Medicine, Baylor University Medical Center, Dallas, Texas 75246, USA.
Insights
Cardiac conditions were the leading cause of death in younger elderly individuals, but noncardiac, nonvascular causes predominated in the oldest age groups. Calcific deposits were common in arteries and valves across all age groups studied.
Area of Science:
- Cardiology
- Gerontology
- Pathology
Background:
- The aging population presents unique challenges in understanding age-related cardiac and vascular changes.
- Autopsy studies provide crucial insights into the causes of death and underlying pathologies in the elderly.
Purpose of the Study:
- To compare clinical and necropsy cardiac findings in octogenarians, nonagenarians, and centenarians.
- To determine the causes of death and the prevalence of specific cardiac conditions and calcific deposits across different extreme age groups.
Main Methods:
- Retrospective analysis of clinical and necropsy data from 490 elderly patients (391 octogenarians, 93 nonagenarians, 6 centenarians).
- Categorization of causes of death into cardiac, noncardiac vascular, and noncardiac nonvascular.
- Assessment of the frequency and severity of coronary artery disease, aortic valve stenosis, cardiac amyloidosis, and calcific deposits in various cardiac structures.
Main Results:
- The frequency of cardiac conditions as the cause of death decreased with age (51% in octogenarians to 0% in centenarians).
- Noncardiac, nonvascular conditions became the predominant cause of death in older age groups (36% in octogenarians to 100% in centenarians).
- Coronary artery disease (62%), aortic valve stenosis (16%), and cardiac amyloidosis (10%) were the main cardiac causes of death. Calcific deposits were prevalent in coronary arteries (81%), aortic valve (47%), and mitral annulus (39%), tending to be less frequent in octogenarians.
Conclusions:
- While cardiac conditions are significant causes of death in the octogenarian group, noncardiac, nonvascular diseases become increasingly dominant in centenarians.
- Age-related calcific deposits in the cardiovascular system are common but may show a slight decrease in frequency with extreme age.
- Understanding these age-related shifts in pathology is crucial for geriatric care and research.
Abstract:
Certain clinical and necropsy cardiac findings are described and compared in 391 octogenarians (80%), 93 nonagenarians (19%), and in 6 centenarians (1%). The number of men and women was similar (248 [51%] and 242 [49%]). The cause of death was cardiac in 228 patients (47%), vascular but noncardiac in 71 (14%), and noncardiac and nonvascular in 191 (39%). The frequency of a cardiac condition causing death decreased with increasing age groups (51% vs 32% vs 0), and the frequency of a noncardiac, nonvascular condition causing death increased with increasing age groups (36% vs 47% vs 100%). Among the cardiac conditions causing death, coronary artery disease was found in 62% of cases (141 of 228), aortic valve stenosis in 16% (36 of 228), and cardiac amyloidosis in 10% of cases (22 of 228). Calcific deposits were found at necropsy in the coronary arteries in 81% of the patients (398 of 490), in the aortic valve in 47% (228 of 490), in the mitral annular area in 39% of the patients (190 of 490), and in 1 or both left ventricular papillary muscles in 25% of the patients (122 of 490). The calcific deposits tended to be less frequent in the octogenarians. Three hundred (61%) of the 490 patients had > or = 1 major coronary arteries narrowed > 75% in cross-sectional area by plaque and the percent of patients in each of the 3 age groups and the percent of coronary arteries significantly narrowed in each of the 3 age groups were similar.