Echocardiographic evaluation of centenarians in Trieste

Abstract

Background Population aging has increased together with the need for cardiovascular care. Understanding the relevance of cardiovascular conditions in the very old is crucial to developing a specific and rationale therapeutic approach. Centenarians can be considered a model of successful aging, although the impact of cardiovascular disease in this population is still unclear.Aim To evaluate the cardiovascular health status of a subset of centenarians enrolled in the Centenari a Trieste study and living in the province of Trieste to describe the prevalence of cardiovascular conditions among them.Methods The current study included 20 individuals born before 1919 and living in the province of Trieste as of 1 May 2019. All centenarians were able to give consent and were subjected to an in-home complete clinical assessment focused on cardiovascular conditions, ECG and echocardiography. ResultsThe majority of centenarians were women (85%) and were not taking any chronic cardiovascular medication (55%). No centenarians had a history of ischemic heart disease while about one-third had signs suggestive of heart failure at examination (20%). Atrial fibrillation was present in 20% of individuals and conduction disorders were uncommon. Although the majority of individuals had a preserved left ventricular function, diastolic function was abnormal in 80% of enrolled centenarians that, however, was mild in 73% of cases.Conclusion This is the second study to perform in-home echocardiography in centenarians and the first to characterize the cardiovascular status of centenarians living in Trieste. The majority of centenarians had asymptomatic diastolic dysfunction and were naı ¨ve from cardiovascular therapy. The recruitment of new individuals from the Trieste area is continuing to perform analyses on clinical, genetic and environmental factors that may predict greater longevity in this geographical context and unveil mechanisms that regulate cardiac aging associated with increased lifespan.

Echocardiographic Features of Longevity: A Cross-Sectional Study of Centenarians

“…The most prevalent cardiovascular co-morbidity in the present cohort was hypertension, which was observed in 77% of patients, and is similar to prior registry data [7][8][9][10]. Aging is associated with vascular changes at the level of the arterial wall media as well as the endothelium, which reduces arterial distensibility and promotes increased vascular stiffness [18].…”

“…Given their longer documented life expectancy it is not surprising that females represented the majority of centenarians in the present study; indeed, the female prevalence in prior small centenarian cohorts has ranged from 60% to 85% [ 7 - 9 ]. Significant differences existed in LV size, systolic function, and estimates of filling pressure between sexes.…”

“…This imparts a significant benefit in the diagnosis and treatment of cardiovascular disorders across age groups. Nevertheless, cardiac structural and physiologic changes have not been studied in centenarians to the extent that they have in younger populations, and published data have generally been limited by small sample sizes and differing methodologies [7][8][9][10]. This investigation aimed to describe the echocardiographic characteristics of a cohort of centenarians at a tertiary referral center and to compare the findings between male and female patients.…”

Clinical implications of assessing frailty in elderly patients treated with permanent cardiac pacing

“…35 In daily practice, pacemaker implantation in the elderly is often performed as an urgent procedure, with the clinical evaluation mainly focused on electrocardiographic data 36,37 and, possibly, on a fast echocardiogram. 38,39 In the new perspective of an integrated cardiogeriatric approach, cardiologists dedicated to arrhythmia management and electrophysiology should start to include frailty assessment among their tools, not only in the field of interventional cardiology, atrial fibrillation and heart failure 35,[40][41][42] but also in the evolving field of cardiac stimulation. 43 Long-term registries will help to better assess the long-term implications of frailty with regard to both outcome and device-related complications.…”

“…The increasing number of elderly people prompts the need for improved clinical management of these patients, with appropriate pathways both in hospital and at home 35 . In daily practice, pacemaker implantation in the elderly is often performed as an urgent procedure, with the clinical evaluation mainly focused on electrocardiographic data 36,37 and, possibly, on a fast echocardiogram 38,39 . In the new perspective of an integrated cardiogeriatric approach, cardiologists dedicated to arrhythmia management and electrophysiology should start to include frailty assessment among their tools, not only in the field of interventional cardiology, atrial fibrillation and heart failure 35,40–42 but also in the evolving field of cardiac stimulation 43 .…”