The striking clinical and pathologic features of hypertrophic cardiomyopathy have been defined almost exclusively in the young. Little is known about this condition in the elderly, although it is assumed to be part of a single disease. Accordingly, we studied 28 patients who were 65 years of age and older (mean age, 72±6.4 years) who were diagnosed as having hypertrophic cardiomyopathy by M-mode, two-dimensional, and Doppler echocardiography and compared them with a group of 28 consecutive patients with this disease who were younger than 40 years of age (mean age, 26±9.5 years). No clinically detectable differences existed between the two groups, except for an increased incidence of mild hypertension in the elderly. Echocardiography in both groups showed hypertrophy with a small left ventricular cavity, and Doppler outflow tract velocity or cardiac catheterization in most patients showed systolic anterior motion of the mitral valve or a systolic outflow tract gradient or both. Significant differences existed between both groups, however, concerning left ventricular size and shape. The elderly group had a predominantly ovoid cavity contour with normal septal curvature. In contrast, in the young group, a markedly abnormal cardiac shape predominated (p<0.0001) with a crescent-shaped left ventricular cavity and a reversed curvature of the interventricular septum. The right ventricular free wall was prominent by echocardiography in the young compared with the elderly group (p<0.001). Apart from a more frequent history of mild hypertension in the elderly, likely related to age, these findings show that hypertrophic cardiomyopathy, when present in the elderly, has similar clinical features to that in the young. However, the elderly had a strikingly different and generally undetected cardiac shape by echocardiography, supporting the notion that hypertrophic cardiomyopathy in the elderly may be a disease distinctively diferent from that which predominates in the young. (Circulation 1989;79:580-589

Testosterone supplementation improves functional capacity, insulin resistance, and muscle strength in women with advanced CHF. Testosterone seems to be an effective and safe therapy for elderly women with CHF.

Background-Depressed left ventricular function (LVF) and low heart rate variability (HRV) identify patients at risk of increased mortality after myocardial infarction (MI). Azimilide, a novel class III antiarrhythmic drug, was investigated for its effects on mortality in patients with depressed LVF after recent MI and in a subpopulation of patients with low HRV. Methods and Results-A total of 3717 post-MI patients with depressed LVF were enrolled in this randomized, placebo-controlled, double-blind study of azimilide 100 mg on all-cause mortality. Placebo patients with low HRV had a significantly higher 1-year mortality than those with high HRV (Ͼ20 U; 15% versus 9.5%, PϽ0.0005) despite nearly identical ejection fractions. No significant differences were observed between the 100-mg azimilide and placebo groups for all-cause mortality in either the "at-risk" patients identified by depressed LVF (12% versus 12%) or the subpopulation of "high-risk" patients identified by low HRV (14% versus 15%) or for total cardiac or arrhythmic mortality. Significantly fewer patients receiving azimilide developed atrial fibrillation than did patients receiving placebo (0.5% versus 1.2%, PϽ0.04). The incidences of torsade de pointes and severe neutropenia (absolute neutrophil count Յ500 cells/L) were slightly higher in the azimilide group than in the placebo group (0.3% versus 0.1% for torsade de pointes and 0.9% versus 0.2% for severe neutropenia). Conclusions-Azimilide