Reference values for Doppler indexes of left ventricular diastolic filling in the elderly.

TLDR: There was evidence for a slight progressive decline in indexes of LV inflow with age, and reference values for the various Doppler parameters were generated on the basis of this healthy elderly cohort.

Abstract: Congestive heart failure increases in prevalence with age. A large number of elderly subjects with heart failure have either normal or slightly reduced left ventricular (LV) systolic function; their symptoms are due to diastolic LV dysfunction. Reference values for Doppler indexes of LV diastolic filling in a large sample of the very elderly (>70) have not been reported previously. The objective of this study was to generate reference values for Doppler indexes of LV filling in a population of apparently healthy elderly men and women. A total of 1201 surviving original subjects of the Framingham Heart Study were evaluated by Doppler echocardiography. A subset of 114 rigorously selected healthy subjects (26 men and 88 women) aged 70 to 87 years (mean 76) constituted the study group. Measurements of seven commonly used Doppler indexes were obtained. Mean and 2.5, 5, 10, 25, 50, 75, 90, 95, and 97.5 percentile values for Doppler diastolic indexes were generated. Stepwise regression analyses were performed to determine the relation of diastolic LV filling to age group (70 to 74 years, 75 to 79 years, and 80 years and over), sex, and other clinical variables. Reference values for the various Doppler parameters were generated on the basis of this healthy elderly cohort. There was evidence for a slight progressive decline in indexes of LV inflow with age. In 87% of this elderly population the ratio of peak early to late velocities of LV diastolic inflow was less than 1.0. Although there were trends toward augmentation of atrial contribution to ventricular filling with advancing age, only peak velocity of late filling (56 vs 62 cm, P = 0.005) changed significantly with age. The present study extends our knowledge of Doppler LV filling patterns in the elderly and documents a minor degree of further impairment in indexes of LV filling with advancing age. The availability of reference Doppler values may prove useful for the identification of LV diastolic dysfunction, which is an important cause of congestive heart failure in the elderly.