Echocardiographic Values in Healthy Elderly People
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ABSTRACTS S54 Abstracts Heart, Lung and Circulation 2008;17S:S1–S209 Results: VVI-derived strain correlated best with MRI- derived RVEF (r = 0.80, P < 0.001). Less but also significant correlations are for the strain rate (r = 0.72; P < 0.001) and RVEF (VVI) (r = 0.59; p < 0.001). Scale of graded VVI indices can be derived corresponding to the severity of RV dysfunction based on MRI and 2D echocardiogram assessment (see Table). Conclusions: VVI-derived strain and strain rate can provide accurate quantitative measures of RV function and can be important additional modalities in the assess- ment of RV function. It can be considered for serial measurements. RV function Normal Mild Moderate Severe RVEF (VVI) % 63 ± 9 48 ± 24 31 ± 14 30 ± 10 RV strain rate (s −1 ) 1.9 ± 0.7 1.7 ± 0.4 1.1 ± 0.2 0.8 ± 0.1 RV strain % 23 ± 5 17 ± 1 11 ± 4 9 ± 3 RV tissue velocity (cm/s) 5.0 ± 1.1 5.1 ± 1.0 3.6 ± 1.8 3.2 ± 1.2 doi:10.1016/j.hlc.2008.05.124 124 Echocardiographic Values in Healthy Elderly People Josephine Harris 1,∗ , Ting Ting Wang 2 , Sharon Mackintosh 2 , Joanna Spry 2 , Christine Rudd 2 , Andrew Russell 1 1 Flinders University of South Australia, Adelaide, South Aus- tralia, Australia; 2 Repatriation General Hospital, Adelaide, South Australia, Australia Background: It is important to differentiate cardiac changes associated with healthy ageing from those related to pathology. Currently published reference ranges are based on small populations with few elderly. Changes in mitral flow patterns with advanced age have been described in small studies but there is little data for novel measures of diastolic function in this group. Objective: To measure echocardiographic parameters in a well defined group of healthy people aged over 80 years. Method: Participants were recruited from the community- based Australian Longitudinal Study of Ageing (ALSA). Those in high-level care, or who reported heart or lung disease in a recent questionnaire were excluded. Sixty- eight subjects were then medically assessed with a history, physical examination and electrocardiogram. Of these, a further 33 were excluded due to overt pathology. Thirty-five subjects (ten males aged 81–94 and twenty-five females aged 80–91) underwent an echocardiogram. Results: The mean (±2 S.D.) end-diastolic left ventricular internal diameter was 4.5 (±1.06) cm and the septal wall thickness was 1.14 (±0.46) cm. The ejection fraction was 70.3 ± 17.1%. The left atrial area was 19.7 (±9.16) cm 2 . The mitral E and A velocities were 0.71 (±0.3) and 0.94 (±0.31) m/s respectively, with the E:A ratio being 0.75 (± 0.38). The medial mitral annular tissue Doppler E velocity was 0.16 (±0.14) m/s and the E:E ratio was 5.5 (±5.8). Conclusion: Our findings may help to differentiate true cardiac pathology from the effects of ageing alone. doi:10.1016/j.hlc.2008.05.125 125 Cardiac Magnetic Resonance—The Gold Standard Inves- tigation for Mitral Regurgitation Severity? Andrew To 1,∗ , Andrew Kerr 1 , Chris Occleshaw 2 , Ruvin Gabriel 1 , Irene Zeng 2 , Brett Cowan 4 , Alistair Young 4 , Gillian Whalley 3 , Ralph Stewart 2 1 Department of Cardiology, Middlemore Hospital, Auckland, New Zealand; 2 Green Lane Cardiovascular Service, Auck- land City Hospital, Auckland, New Zealand; 3 Department of Medicine, University of Auckland, Auckland, New Zealand; 4 Centre for Advanced Magnetic Resonance Imaging, University of Auckland, Auckland, New Zealand Background: Quantification of mitral regurgitation (MR) by echocardiography is technically demanding, depen- dent on geometric assumptions and is prone to mea- surement error. In cardiac magnetic resonance (CMR), MR is quantified by the difference between left ventric- ular stroke volume (LVSV) obtained by gradient echo cine imaging and forward aortic flow obtained by velocity- encoded cine imaging. Methods: In 25 patients with moderate to severe MR, we compared quantification of MR regurgitant volume by CMR with both the Doppler-volumetric and PISA meth- ods by echocardiography. To validate the CMR method of MR quantification and exclude systematic bias, we stud- ied 20 patients without known MR across a range of left ventricular size and function. We would expect aortic flow and LVSV to be near identical in these patients. Results: In the 25 MR patients mean left ventricular end- diastolic volume (LVEDV) was 229 ± 50 ml by CMR. The regurgitant volume by CMR was 59 ± 36 ml, compared with 84 ± 38 ml and 96 ± 42 ml by the echo-volumetrics and PISA, respectively. There was significant systematic difference between CMR and echocardiographic mea- sures (p < 0.001). In patients without known MR, the mean LVEDV was 217 ± 58 ml. CMR-volumetric measurement of LVSV was 107 ± 28 ml, which corresponded tightly with the flow-derived measurement of forward aortic flow of 108 ± 30 ml, with a correlation coefficient of 0.964. The mean difference between LVSV and forward aortic flow was 0.5 ± 7.8 ml. Conclusion: MR quantification by echocardiography over- estimates MR severity compared with CMR. This is not due to systematic error in the CMR measurements. doi:10.1016/j.hlc.2008.05.126
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Transcript of Echocardiographic Values in Healthy Elderly People
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S54 Abstracts Heart, Lung and Circulation2008;17S:S1–S209
Results: VVI-derived strain correlated best with MRI-derived RVEF (r = 0.80, P < 0.001). Less but also significantcorrelations are for the strain rate (r = 0.72; P < 0.001)and RVEF (VVI) (r = 0.59; p < 0.001). Scale of graded VVIindices can be derived corresponding to the severity ofRV dysfunction based on MRI and 2D echocardiogramassessment (see Table).Conclusions: VVI-derived strain and strain rate canprovide accurate quantitative measures of RV functionand can be important additional modalities in the assess-ment of RV function. It can be considered for serialmeasurements.
RV function
Normal Mild Moderate Severe
RVEF (VVI) % 63 ± 9 48 ± 24 31 ± 14 30 ± 10
RV strain rate (s−1) 1.9 ± 0.7 1.7 ± 0.4 1.1 ± 0.2 0.8 ± 0.1
RV strain % 23 ± 5 17 ± 1 11 ± 4 9 ± 3
RV tissue velocity (cm/s) 5.0 ± 1.1 5.1 ± 1.0 3.6 ± 1.8 3.2 ± 1.2
doi:10.1016/j.hlc.2008.05.124
124Echocardiographic Values in Healthy Elderly People
Josephine Harris 1,∗, Ting Ting Wang 2, SharonMackintosh 2, Joanna Spry 2, Christine Rudd 2, Andrew
Conclusion: Our findings may help to differentiate truecardiac pathology from the effects of ageing alone.
doi:10.1016/j.hlc.2008.05.125
125Cardiac Magnetic Resonance—The Gold Standard Inves-tigation for Mitral Regurgitation Severity?
Andrew To 1,∗, Andrew Kerr 1, Chris Occleshaw 2, RuvinGabriel 1, Irene Zeng 2, Brett Cowan 4, Alistair Young 4,Gillian Whalley 3, Ralph Stewart 2
1 Department of Cardiology, Middlemore Hospital, Auckland,New Zealand; 2 Green Lane Cardiovascular Service, Auck-land City Hospital, Auckland, New Zealand; 3 Departmentof Medicine, University of Auckland, Auckland, New Zealand;4 Centre for Advanced Magnetic Resonance Imaging, Universityof Auckland, Auckland, New Zealand
Background: Quantification of mitral regurgitation (MR)by echocardiography is technically demanding, depen-dent on geometric assumptions and is prone to mea-surement error. In cardiac magnetic resonance (CMR),MR is quantified by the difference between left ventric-ular stroke volume (LVSV) obtained by gradient echo cineimaging and forward aortic flow obtained by velocity-encoded cine imaging.Methods: In 25 patients with moderate to severe MR, we
Russell 1
1 Flinders University of South Australia, Adelaide, South Aus-tralia, Australia; 2 Repatriation General Hospital, Adelaide,South Australia, Australia
Background: It is important to differentiate cardiacchanges associated with healthy ageing from those relatedto pathology. Currently published reference ranges arebased on small populations with few elderly. Changesin mitral flow patterns with advanced age have beendescribed in small studies but there is little data for novelmeasures of diastolic function in this group.Objective: To measure echocardiographic parameters in awell defined group of healthy people aged over 80 years.Method: Participants were recruited from the community-based Australian Longitudinal Study of Ageing (ALSA).Those in high-level care, or who reported heart or lungdisease in a recent questionnaire were excluded. Sixty-eight subjects were then medically assessed with a history,physical examination and electrocardiogram. Of these,a further 33 were excluded due to overt pathology.Thirty-five subjects (ten males aged 81–94 and twenty-fivefemales aged 80–91) underwent an echocardiogram.Results: The mean (±2 S.D.) end-diastolic left ventricularinternal diameter was 4.5 (±1.06) cm and the septal wallthickness was 1.14 (±0.46) cm. The ejection fraction was70.3 ± 17.1%. The left atrial area was 19.7 (±9.16) cm2. Themitral E and A velocities were 0.71 (±0.3) and 0.94 (±0.31)m/s respectively, with the E:A ratio being 0.75 (± 0.38). Themedial mitral annular tissue Doppler E velocity was 0.16(±0.14) m/s and the E:E′ ratio was 5.5 (±5.8).
compared quantification of MR regurgitant volume byCMR with both the Doppler-volumetric and PISA meth-ods by echocardiography. To validate the CMR method ofMR quantification and exclude systematic bias, we stud-ied 20 patients without known MR across a range of leftventricular size and function. We would expect aortic flowand LVSV to be near identical in these patients.Results: In the 25 MR patients mean left ventricular end-diastolic volume (LVEDV) was 229 ± 50 ml by CMR. Theregurgitant volume by CMR was 59 ± 36 ml, comparedwith 84 ± 38 ml and 96 ± 42 ml by the echo-volumetricsand PISA, respectively. There was significant systematicdifference between CMR and echocardiographic mea-sures (p < 0.001). In patients without known MR, the meanLVEDV was 217 ± 58 ml. CMR-volumetric measurement ofLVSV was 107 ± 28 ml, which corresponded tightly withthe flow-derived measurement of forward aortic flow of108 ± 30 ml, with a correlation coefficient of 0.964. Themean difference between LVSV and forward aortic flowwas 0.5 ± 7.8 ml.Conclusion: MR quantification by echocardiography over-estimates MR severity compared with CMR. This is notdue to systematic error in the CMR measurements.
doi:10.1016/j.hlc.2008.05.126
